MEDICARE: KATHLEEN KOVACH

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
1	225X00000X	Occupational Therapist		MI

General Provider Information

NPI Number	:	1821498411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KOVACH

Provider Business Mailing Address
First Line	:	43345 WESTVIEW DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-2170
Country	:	US
Telephone Number	:	586-321-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	43345 WESTVIEW DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-2170
Country	:	US
Telephone Number	:	586-321-5882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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Directions to “ KATHLEEN KOVACH ” Practice Location

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