Provider Demographics
NPI:1356018956
Name:KOSCHER, KIMBERLY J (BS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:KOSCHER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1826
Mailing Address - Country:US
Mailing Address - Phone:574-276-6092
Mailing Address - Fax:
Practice Address - Street 1:1711 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1826
Practice Address - Country:US
Practice Address - Phone:574-276-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist