Individual
MRS. JESSICA ELAINE KOEHNEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
101 W DUPONT RD, FORT WAYNE, IN 46825-1915
(260) 489-1774
(260) 489-1777
Mailing address
101 W DUPONT RD, FORT WAYNE, IN 46825-1915
(260) 489-1774
(260) 489-1777
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
12/13/2024
Last updated
12/13/2024
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