Provider Demographics
NPI:1114465424
Name:KOCHOBAY, ANGELA MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:KOCHOBAY
Suffix:
Gender:F
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 1:5705 CARTER WOODS CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6974
Mailing Address - Country:US
Mailing Address - Phone:267-730-9411
Mailing Address - Fax:803-728-3291
Practice Address - Street 1:5705 CARTER WOODS CT
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6974
Practice Address - Country:US
Practice Address - Phone:267-730-9411
Practice Address - Fax:803-728-3291
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11444225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8975Medicaid
NC14171387Medicaid