Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1649452707 |
---|---|
Provider Name | Max W Koch |
First Address | Mansfield, TX 76063-3235 |
Second Address | Mansfield, TX 76063-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2007 |
Last Update Date | 05/12/2007 |