Provider Demographics
NPI:1134286768
Name:KOTCH, MICHAEL R
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:KOTCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2111
Mailing Address - Country:US
Mailing Address - Phone:610-282-2575
Mailing Address - Fax:610-282-3076
Practice Address - Street 1:343 S 3RD ST
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2111
Practice Address - Country:US
Practice Address - Phone:610-282-2575
Practice Address - Fax:610-282-3076
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-015764103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling