Healthcare Provider Details

I. General information

NPI: 1265731798
Provider Name (Legal Business Name): ERICA KOCH ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 S MAIN ST
RANDOLPH VT
05060-1363
US

IV. Provider business mailing address

43 S MAIN ST
RANDOLPH VT
05060-1363
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-9600
  • Fax: 888-283-8349
Mailing address:
  • Phone: 802-728-9600
  • Fax: 888-283-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099-0071770
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: