Healthcare Provider Details

I. General information

NPI: 1164694436
Provider Name (Legal Business Name): PAMELA J KOCH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA J OLIVER AU.D.

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BENEDICT AVE STE 109
NORWALK OH
44857-2112
US

IV. Provider business mailing address

85 BENEDICT AVE STE 109
NORWALK OH
44857-2112
US

V. Phone/Fax

Practice location:
  • Phone: 419-668-0401
  • Fax:
Mailing address:
  • Phone: 419-668-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.01572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: