Provider Demographics
NPI:1912320151
Name:KOEHLER, MARTHA JOANN (LMT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JOANN
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 30TH STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714
Mailing Address - Country:US
Mailing Address - Phone:330-491-0381
Mailing Address - Fax:330-491-0388
Practice Address - Street 1:807 30TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1404
Practice Address - Country:US
Practice Address - Phone:330-491-0381
Practice Address - Fax:330-491-0388
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist