1730680612 NPI number — CHRISTINE MARION KOCH MOT, OTR/L, CBIS

Table of content: CHRISTINE MARION KOCH MOT, OTR/L, CBIS (NPI 1730680612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730680612 NPI number — CHRISTINE MARION KOCH MOT, OTR/L, CBIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCH
Provider First Name:
CHRISTINE
Provider Middle Name:
MARION
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR/L, CBIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730680612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 SMITH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-4712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-646-0664
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4949 COOLIDGE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-655-5800
Provider Business Practice Location Address Fax Number:
248-655-5801
Provider Enumeration Date:
02/26/2018

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: 225XN1300X , with the licence number:  5201007735 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com