Provider Demographics
NPI:1922211168
Name:KOCH, ALISON R (COTA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:R
Last Name:KOCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
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Mailing Address - Street 1:236 CENTAURIAN DR
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-3821
Mailing Address - Country:US
Mailing Address - Phone:856-753-0894
Mailing Address - Fax:
Practice Address - Street 1:2150 ROUTE 38
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4302
Practice Address - Country:US
Practice Address - Phone:856-667-4550
Practice Address - Fax:856-667-3507
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09052800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant