Individual
MRS. MARISA KOHNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1120 S CALUMET RD STE 3, CHESTERTON, IN 46304-3286
(219) 983-9675
(219) 983-9681
Mailing address
3252 ATLANTA BLVD, PORTAGE, IN 46368-5150
(219) 762-9373
(219) 983-9681
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003944A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000387925
ANTHEM PROVIDER PIN
IN
Enumeration date
11/01/2006
Last updated
07/09/2007
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