Provider Demographics
NPI:1083872345
Name:KOCSIS, GEORGE RONALD JR (OTR/L)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RONALD
Last Name:KOCSIS
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROVIDENCE ST. MARY MEDICAL CENTER 401 W. POPLAR ST.
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-897-2100
Mailing Address - Fax:509-897-5508
Practice Address - Street 1:PROVIDENCE ST. MARY MEDICAL CENTER 401 W. POPLAR ST.
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4619
Practice Address - Country:US
Practice Address - Phone:509-897-2100
Practice Address - Fax:509-897-5508
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113371225X00000X
IDOT-498225X00000X
WAOT00002963225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist