Healthcare Provider Details

I. General information

NPI: 1568129708
Provider Name (Legal Business Name): RACHAEL KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 COLUMBUS AVE STE B
SANDUSKY OH
44870-3546
US

IV. Provider business mailing address

1725 COLUMBUS AVE STE B
SANDUSKY OH
44870-3546
US

V. Phone/Fax

Practice location:
  • Phone: 419-273-0449
  • Fax: 419-600-2249
Mailing address:
  • Phone: 419-273-0449
  • Fax: 419-600-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: