Healthcare Provider Details

I. General information

NPI: 1952054637
Provider Name (Legal Business Name): ANN KOCH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA KOCH LMT

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N WATER ST
SILVERTON OR
97381-1645
US

IV. Provider business mailing address

417 N WATER ST
SILVERTON OR
97381-1645
US

V. Phone/Fax

Practice location:
  • Phone: 503-902-9093
  • Fax:
Mailing address:
  • Phone: 503-902-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26733
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: