Individual
ANGELA KOESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5250 N 100TH ST, DIETERICH, IL 62424
(217) 994-4977
Mailing address
5250 N 100TH ST, DIETERICH, IL 62424-2024
(217) 994-4977
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004384
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24Z00000X
TAXONOMY CODE
—
Enumeration date
10/20/2016
Last updated
10/20/2016
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