Provider Demographics
NPI:1154723419
Name:KOEHN, SARAH (MS, LAT, ATC, EMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KOEHN
Suffix:
Gender:F
Credentials:MS, LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20916 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9135
Mailing Address - Country:US
Mailing Address - Phone:410-236-7635
Mailing Address - Fax:
Practice Address - Street 1:20916 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9135
Practice Address - Country:US
Practice Address - Phone:410-236-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0202078146N00000X
MDA0000562081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic