Provider Demographics
NPI:1639369317
Name:KOCA, WENDY MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:KOCA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-0776
Mailing Address - Country:US
Mailing Address - Phone:509-876-6600
Mailing Address - Fax:
Practice Address - Street 1:101 N WYNOOCHEE DR SW
Practice Address - Street 2:
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569-0776
Practice Address - Country:US
Practice Address - Phone:509-876-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00001243224Z00000X
WAMA60824646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant