Provider Demographics
NPI:1922655109
Name:KOH, SANDY H
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:H
Last Name:KOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 HUDSON TER APT B7
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7910
Mailing Address - Country:US
Mailing Address - Phone:201-414-2762
Mailing Address - Fax:
Practice Address - Street 1:2339 HUDSON TER APT B7
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7910
Practice Address - Country:US
Practice Address - Phone:201-414-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant