Provider Demographics
NPI:1790369965
Name:KOCIBA, BETH ELAINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ELAINE
Last Name:KOCIBA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ELAINE
Other - Last Name:ESCHKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1390 COURTNEY CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-3460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 WATER TOWER PL
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2668
Practice Address - Country:US
Practice Address - Phone:248-625-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003517225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation