Provider Demographics
NPI:1225331598
Name:KOCH, KATHLEEN J (LAC, MAOM, DIPOM)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:J
Last Name:KOCH
Suffix:
Gender:F
Credentials:LAC, MAOM, DIPOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 ROCK DOVE CT # 201
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8655
Mailing Address - Country:US
Mailing Address - Phone:941-979-2004
Mailing Address - Fax:
Practice Address - Street 1:1401 TAMIAMI TRL STE B
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5907
Practice Address - Country:US
Practice Address - Phone:941-979-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist