Healthcare Provider Details

I. General information

NPI: 1750959219
Provider Name (Legal Business Name): ZOIE KOCH OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 N TOWN CENTER DR
LAS VEGAS NV
89144-6367
US

IV. Provider business mailing address

2634 SUNDAY GRACE DR
HENDERSON NV
89052-2842
US

V. Phone/Fax

Practice location:
  • Phone: 702-277-9895
  • Fax:
Mailing address:
  • Phone: 702-277-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3021
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: