Healthcare Provider Details

I. General information

NPI: 1972982346
Provider Name (Legal Business Name): TROY M KOCHEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 CONGER AVE NW
OLYMPIA WA
98502-4866
US

IV. Provider business mailing address

PO BOX 7152
OLYMPIA WA
98507-7152
US

V. Phone/Fax

Practice location:
  • Phone: 360-359-1068
  • Fax:
Mailing address:
  • Phone: 360-359-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: