Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 205 | OH |
Y | 225XG0600X | Occupational Therapist - Gerontology | R0787 | KY |
NPI | 1225372287 |
---|---|
Provider Name | Mrs. Kathleen Diane Koch |
First Address | Cincinnati, OH 45255-5656 |
Second Address | Seven Fields, PA 16046-7861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |