Provider Demographics
NPI:1215069547
Name:HOHENSTREET, CAROL L
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:HOHENSTREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:402 NORTH SERVICE ROAD
Mailing Address - City:WRIGHT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63390-0198
Mailing Address - Country:US
Mailing Address - Phone:636-745-7200
Mailing Address - Fax:636-745-3613
Practice Address - Street 1:402 NORTH SERVICE RD
Practice Address - Street 2:R-II
Practice Address - City:WRIGHT CITY
Practice Address - State:MO
Practice Address - Zip Code:63390-0198
Practice Address - Country:US
Practice Address - Phone:636-745-7200
Practice Address - Fax:636-745-3613
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO476880737Medicaid