Provider Demographics
NPI:1427535186
Name:KOCH, NANCY DIXON (LSLS CERT AVED)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:DIXON
Last Name:KOCH
Suffix:
Gender:F
Credentials:LSLS CERT AVED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2873
Mailing Address - Country:US
Mailing Address - Phone:727-967-1036
Mailing Address - Fax:
Practice Address - Street 1:2 COLEMAN DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2873
Practice Address - Country:US
Practice Address - Phone:727-967-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No252Y00000XAgenciesEarly Intervention Provider Agency