Healthcare Provider Details

I. General information

NPI: 1861818411
Provider Name (Legal Business Name): JENNA KOCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18445 HOLLY RD
FORT MYERS FL
33967-3326
US

IV. Provider business mailing address

18445 HOLLY RD
FORT MYERS FL
33967-3326
US

V. Phone/Fax

Practice location:
  • Phone: 239-432-2798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: