Provider Demographics
NPI:1861790214
Name:KOHLER, KENNETH W (LMT 7117 SC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:W
Last Name:KOHLER
Suffix:
Gender:M
Credentials:LMT 7117 SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GOLD OAK DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1473
Mailing Address - Country:US
Mailing Address - Phone:843-298-5069
Mailing Address - Fax:
Practice Address - Street 1:28 GOLD OAK DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1473
Practice Address - Country:US
Practice Address - Phone:843-298-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7117OtherMT