Healthcare Provider Details

I. General information

NPI: 1770060626
Provider Name (Legal Business Name): ANTOINETTE KOTCHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 SARGENT RD NE APT 109
WASHINGTON DC
20017-2830
US

IV. Provider business mailing address

5120 SARGENT RD NE APT 109
WASHINGTON DC
20017-2830
US

V. Phone/Fax

Practice location:
  • Phone: 202-297-1366
  • Fax:
Mailing address:
  • Phone: 202-297-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: