Most Relevant Information
Provider Data
| NPI Number: | 1003673906 |
| Provider Name: | MATTHEW KOESTERER COTA/L |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 057.006101 |
Most Important Dates
| Enumeration Date: | 03/06/2024 |
| Last Updated: | 03/06/2024 |
Provider Practice Location
746 URBANNA DR
FREEBURG
IL
622431904
Practice Location Phone/Fax
| Phone: | 6185395856 |
| Fax: |
Provider Mailing Location
30 RIO VERDE DR
BELLEVILLE
IL
622213124
Provider Mailing Phone/Fax
| Phone: | 6186043508 |
| Fax: |