Provider Demographics
NPI:1437420585
Name:KOO, MI (TVI)
Entity Type:Individual
Prefix:MS
First Name:MI
Middle Name:
Last Name:KOO
Suffix:
Gender:F
Credentials:TVI
Other - Prefix:MS
Other - First Name:MI
Other - Middle Name:Y
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TVI
Mailing Address - Street 1:24129A OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2616
Mailing Address - Country:US
Mailing Address - Phone:917-445-0597
Mailing Address - Fax:
Practice Address - Street 1:24129A OAK PARK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2616
Practice Address - Country:US
Practice Address - Phone:917-445-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind