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NPI Code Detail

MEDICARE: ABIGAIL LYN KOCH RBT

MEDICARE: ABIGAIL LYN KOCH RBT
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 Technician1017394TN

General Provider Information

NPI Number : 1902596307
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL LYN KOCH RBT
Provider Business Mailing Address
First Line : 1507 HICKORY VALLEY RD APT A6
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-5610
Country : US
Telephone Number : 629-867-0618
Fax Number :
Provider Business Practice Location Address
First Line : 206 S JEFFERSON AVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-4748
Country : US
Telephone Number : 844-244-1818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2023
Last Update Date : 10/29/2024

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