Healthcare Provider Details

I. General information

NPI: 1134286768
Provider Name (Legal Business Name): DR. MICHAEL R KOTCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 S 3RD ST
COOPERSBURG PA
18036-2111
US

IV. Provider business mailing address

343 S 3RD ST
COOPERSBURG PA
18036-2111
US

V. Phone/Fax

Practice location:
  • Phone: 610-282-2575
  • Fax: 610-282-3076
Mailing address:
  • Phone: 610-282-2575
  • Fax: 610-282-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS-015764
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: