Provider Demographics
NPI:1003449315
Name:KOCH, CAITLIN LAINE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:LAINE
Last Name:KOCH
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19230 POPLAR TRAILS LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1768
Mailing Address - Country:US
Mailing Address - Phone:832-247-8622
Mailing Address - Fax:
Practice Address - Street 1:19230 POPLAR TRAILS LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1768
Practice Address - Country:US
Practice Address - Phone:832-247-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXAT88952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program