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NPI Code Detail

MEDICARE: WYATT GREGORY KOCOL

MEDICARE: WYATT GREGORY KOCOL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1386379550
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYATT GREGORY KOCOL
Provider Business Mailing Address
First Line : 295 89TH ST STE 306
Second Line :
City : DALY CITY
State : CA
Zip : 94015-1656
Country : US
Telephone Number : 877-264-6747
Fax Number :
Provider Business Practice Location Address
First Line : 9745 E HAMPDEN AVE STE 210
Second Line :
City : DENVER
State : CO
Zip : 80231-4922
Country : US
Telephone Number : 877-264-6747
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2022
Last Update Date : 07/20/2022

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Directions to “ WYATT GREGORY KOCOL ” Practice Location

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