Healthcare Provider Details

I. General information

NPI: 1518239771
Provider Name (Legal Business Name): ELIZABETH CATHLEEN KOCHER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CATHLEEN GAYDOS

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 W 24TH ST
PARMA OH
44134
US

IV. Provider business mailing address

200 DORLAND AVE
BEREA OH
44017-2806
US

V. Phone/Fax

Practice location:
  • Phone: 440-885-2424
  • Fax:
Mailing address:
  • Phone: 330-283-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-007924
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: