Healthcare Provider Details

I. General information

NPI: 1386043511
Provider Name (Legal Business Name): ANITA KOCH LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 UNION ST APT 316
SEATTLE WA
98101-1948
US

IV. Provider business mailing address

1000 UNION ST APT 316
SEATTLE WA
98101-1948
US

V. Phone/Fax

Practice location:
  • Phone: 206-579-3391
  • Fax:
Mailing address:
  • Phone: 206-579-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60427080
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: