Provider Demographics
NPI:1003965468
Name:KOCH, KAREN KELLY (OTR)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:KELLY
Last Name:KOCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-9117
Mailing Address - Country:US
Mailing Address - Phone:269-978-8340
Mailing Address - Fax:866-576-3284
Practice Address - Street 1:3243 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-9117
Practice Address - Country:US
Practice Address - Phone:269-978-8340
Practice Address - Fax:866-576-3284
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003832225X00000X, 225XE0001X, 225XF0002X, 225XG0600X
225XL0004X, 225XP0200X, 225XE0001X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology