Provider Demographics
NPI:1942218235
Name:KOCHE, MANOHAR D (BACHELORS DEGREE OT)
Entity Type:Individual
Prefix:
First Name:MANOHAR
Middle Name:D
Last Name:KOCHE
Suffix:
Gender:M
Credentials:BACHELORS DEGREE OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2493 FOREST MEADOWS CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7931
Mailing Address - Country:US
Mailing Address - Phone:616-942-8041
Mailing Address - Fax:
Practice Address - Street 1:3181 PRAIRIE ST SW STE 102
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2076
Practice Address - Country:US
Practice Address - Phone:616-249-3545
Practice Address - Fax:616-249-3549
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP02750001Medicare ID - Type Unspecified