Miranda Koesterer, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056.013548 Issued in IL

Practice address

844 Cambridge Blvd
O Fallon, IL 62269-1976

Phone

(618) 624-9900

NPI assigned

Mar 31, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Miranda Paulus Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1659909950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 PARKLAND BLVD APT 15",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697369",
            "telephone_number": "567-644-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "844 CAMBRIDGE BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691976",
            "telephone_number": "618-624-9900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Junction Dr W Ste 4",
            "address_purpose": "LOCATION",
            "city": "Glen Carbon",
            "state": "IL",
            "postal_code": "620343060",
            "country_code": "US",
            "telephone_number": "618-288-8020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOESTERER",
        "first_name": "MIRANDA",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2020009519",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.013548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "PAULUS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tracie Kloeppel, CRNA
• Vivian M Kloke, OD
• Megan Samantha Knetzer, FNP
• Richard Gerhard Knight, MSN FNP-BC
• Kelsey Elyse Koenig, PA-C
• Haley Marie Kohnen, PTA
• Torre Kohrmann, RBT
• Caitlyn Nicol Kolo
• Greg S Komeshak, D.C.
• Mallory Kay Kovarik, PHARMD

• Occupational Therapist in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.