Healthcare Provider Details

I. General information

NPI: 1043403330
Provider Name (Legal Business Name): LAURA KOCH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 E GRANT RD
TUCSON AZ
85716-2717
US

IV. Provider business mailing address

6655 N CANYON CREST DR UNIT 25201
TUCSON AZ
85750-0987
US

V. Phone/Fax

Practice location:
  • Phone: 520-326-2782
  • Fax:
Mailing address:
  • Phone: 520-204-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2199
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: