Healthcare Provider Details

I. General information

NPI: 1558138370
Provider Name (Legal Business Name): CAROL KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 MAIN ST
HAMILTON OH
45013-1635
US

IV. Provider business mailing address

189 SAMPLE RD
OXFORD OH
45056-9226
US

V. Phone/Fax

Practice location:
  • Phone: 513-785-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number01119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: