Provider Demographics
NPI:1821407081
Name:MOLLY KOCZARSKI
Entity Type:Organization
Organization Name:MOLLY KOCZARSKI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCZARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:360-580-5423
Mailing Address - Street 1:18811 19TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4136
Mailing Address - Country:US
Mailing Address - Phone:360-580-5423
Mailing Address - Fax:
Practice Address - Street 1:18811 19TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4136
Practice Address - Country:US
Practice Address - Phone:360-580-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60083621261QM1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1103XAmbulatory Health Care FacilitiesClinic/CenterMilitary Ambulatory Procedure Visits Operational (Transportable)