Provider Demographics
NPI:1245772656
Name:COUCH, PATRICIA (ATP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1406
Mailing Address - Country:US
Mailing Address - Phone:360-424-4356
Mailing Address - Fax:360-424-0938
Practice Address - Street 1:1911 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-6703
Practice Address - Country:US
Practice Address - Phone:360-424-4356
Practice Address - Fax:360-848-0938
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAATP526247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other