MEDICARE: SHANNON KOSCH OTR

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	713	NE

General Provider Information

NPI Number	:	1396967089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON KOSCH OTR

Provider Business Mailing Address
First Line	:	1922 15TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-5127
Country	:	US
Telephone Number	:	402-563-3718
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 19TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4248
Country	:	US
Telephone Number	:	402-562-3341
Fax Number	:	402-564-0730

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	11/09/2009

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Directions to “ SHANNON KOSCH OTR” Practice Location

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