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General NPI Number Information
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NPI Number | 1306464300
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Entity Type | Individual
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Provider Name | KRISTIE R KOCH BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 7375 W US 52
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City | NEW PALESTINE
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State | IN
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Zip | 46163-8950
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Country | US
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Telephone | 888-877-7222
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Fax | 317-978-3478
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Provider Business Mailing Address
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Address Line | 2342 S COPPERSTONE DR
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City | NEW PALESTINE
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State | IN
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Zip | 46163-8036
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Country | US
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Telephone | 765-661-9790
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Fax | 317-978-3478
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-40759
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License Number State |
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