Healthcare Provider Details

I. General information

NPI: 1326558693
Provider Name (Legal Business Name): JUANITA KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29133 HEALTH CAMPUS DR
WESTLAKE OH
44145-5256
US

IV. Provider business mailing address

29133 HEALTH CAMPUS DR
WESTLAKE OH
44145-5256
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-6212
  • Fax: 440-899-4396
Mailing address:
  • Phone: 440-835-6212
  • Fax: 440-899-4396

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: