Provider Demographics
NPI:1467586990
Name:KOCH, LYNNE VOCKE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:VOCKE
Last Name:KOCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 MENORCA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1108
Mailing Address - Country:US
Mailing Address - Phone:858-560-6210
Mailing Address - Fax:
Practice Address - Street 1:1005 47TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3626
Practice Address - Country:US
Practice Address - Phone:619-262-7342
Practice Address - Fax:619-262-8918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 876225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner