Provider Demographics
NPI:1093478034
Name:KOSCH, KIMBERLY ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:KOSCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 W LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6326
Mailing Address - Country:US
Mailing Address - Phone:308-391-0018
Mailing Address - Fax:
Practice Address - Street 1:3119 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4199
Practice Address - Country:US
Practice Address - Phone:308-384-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1088224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant