1639341704 NPI number — MRS. JODY MARIE RIVERA KOCA OTR

Table of content: MRS. JODY MARIE RIVERA KOCA OTR (NPI 1639341704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639341704 NPI number — MRS. JODY MARIE RIVERA KOCA OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCA
Provider First Name:
JODY
Provider Middle Name:
MARIE RIVERA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
JODY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639341704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8546 S LEWIS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80127-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-220-9487
Provider Business Mailing Address Fax Number:
720-922-0714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8546 S LEWIS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80127-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-220-9487
Provider Business Practice Location Address Fax Number:
720-922-0714
Provider Enumeration Date:
03/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1010497 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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