Provider Demographics
NPI:1811567449
Name:KOCH, COURTNEY MICHELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:KOCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:VASSEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2267 ALGIERS ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7449
Mailing Address - Country:US
Mailing Address - Phone:859-496-1859
Mailing Address - Fax:
Practice Address - Street 1:7536 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1985
Practice Address - Country:US
Practice Address - Phone:859-918-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist