MEDICARE: JEANETTE KOETH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1063058626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE KOETH

Provider Business Mailing Address
First Line	:	8701 KUHL RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16510-4937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 KUHL RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16510-4937
Country	:	US
Telephone Number	:	814-969-9810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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Directions to “ JEANETTE KOETH ” Practice Location

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