Provider Demographics
NPI:1164694436
Name:KOCH, PAMELA J (AUD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:KOCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:85 BENEDICT AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2112
Mailing Address - Country:US
Mailing Address - Phone:419-668-0401
Mailing Address - Fax:
Practice Address - Street 1:85 BENEDICT AVE STE 109
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2112
Practice Address - Country:US
Practice Address - Phone:419-668-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01572231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOL4246401OtherMEDICARE PTAN