Provider Demographics
NPI:1760826473
Name:KOSER, PATRICE MARIE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:MARIE
Last Name:KOSER
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 1:118 BROWN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7739
Mailing Address - Country:US
Mailing Address - Phone:931-456-6608
Mailing Address - Fax:
Practice Address - Street 1:118 BROWN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-7739
Practice Address - Country:US
Practice Address - Phone:931-456-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1653224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant