Healthcare Provider Details

I. General information

NPI: 1083532691
Provider Name (Legal Business Name): AMY LYNNE KOCH RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ROBERT PITT DR
MONSEY NY
10952-3330
US

IV. Provider business mailing address

101 BRANDENBERRY RD
BRUNSWICK GA
31523-6090
US

V. Phone/Fax

Practice location:
  • Phone: 844-543-7178
  • Fax:
Mailing address:
  • Phone: 848-454-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT25504196
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: