Provider Demographics
NPI:1255854782
Name:KOCH, MELANIE CAROL (OT/L)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:CAROL
Last Name:KOCH
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 WARMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2462
Mailing Address - Country:US
Mailing Address - Phone:804-502-9088
Mailing Address - Fax:
Practice Address - Street 1:1707 WARMINSTER DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2462
Practice Address - Country:US
Practice Address - Phone:804-379-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000941225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist