Provider Demographics
NPI:1073008249
Name:KODHI, HICHAM (MT)
Entity Type:Individual
Prefix:
First Name:HICHAM
Middle Name:
Last Name:KODHI
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MEADOW LN STE 8
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HGTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-3764
Mailing Address - Country:US
Mailing Address - Phone:513-307-8073
Mailing Address - Fax:
Practice Address - Street 1:6200 PFEIFFER RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5862
Practice Address - Country:US
Practice Address - Phone:513-246-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty