Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 33.12965 | OH |
NPI | 1013512441 |
---|---|
Provider Name | Heidi Koch |
First Address | Mount Vernon, OH 43050-1977 |
Second Address | Mount Vernon, OH 43050-1977 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2020 |
Last Update Date | 03/12/2020 |