Healthcare Provider Details

I. General information

NPI: 1477648194
Provider Name (Legal Business Name): MARTHA KOB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S.VALLEY RD.
PAOLI PA
19301
US

IV. Provider business mailing address

854 RICHARDS RD.
WAYNE PA
19087
US

V. Phone/Fax

Practice location:
  • Phone: 610-265-3455
  • Fax:
Mailing address:
  • Phone: 610-265-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC001263
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN248436L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: