Healthcare Provider Details

I. General information

NPI: 1467586990
Provider Name (Legal Business Name): LYNNE VOCKE KOCH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 47TH ST
SAN DIEGO CA
92102-3626
US

IV. Provider business mailing address

5896 MENORCA DR
SAN DIEGO CA
92124-1108
US

V. Phone/Fax

Practice location:
  • Phone: 619-262-7342
  • Fax: 619-262-8918
Mailing address:
  • Phone: 858-560-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberOT 876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: