Individual
MR. WAYLON GENE KOEHLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
602 SE WALLOCK ST, LAWTON, OK 73501-5444
(580) 585-5577
(580) 248-9377
Mailing address
602 SE WALLOCK ST, LAWTON, OK 73501-5444
(580) 585-5577
(580) 248-9377
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TA1713
OK
Other
Enumeration date
10/23/2008
Last updated
10/23/2008
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