Provider Demographics
NPI:1518239771
Name:KOCHER, ELIZABETH CATHLEEN (OT)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:CATHLEEN
Last Name:KOCHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CATHLEEN
Other - Last Name:GAYDOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 DORLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2806
Mailing Address - Country:US
Mailing Address - Phone:330-283-8330
Mailing Address - Fax:
Practice Address - Street 1:5331 W 24TH ST
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134
Practice Address - Country:US
Practice Address - Phone:440-885-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-007924225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3055563Medicaid
OH3055563Medicaid