Healthcare Provider Details

I. General information

NPI: 1578295952
Provider Name (Legal Business Name): MAEGAN KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 06/25/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 E RD
CENTRALIA KS
66415-8038
US

IV. Provider business mailing address

437 E RD
CENTRALIA KS
66415-8038
US

V. Phone/Fax

Practice location:
  • Phone: 785-294-2388
  • Fax:
Mailing address:
  • Phone: 785-294-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: