Provider Demographics
NPI:1245070838
Name:DAVIES, MARY KOCH (MS OTR/L)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KOCH
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELISSA
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:334 VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2766
Mailing Address - Country:US
Mailing Address - Phone:419-301-4814
Mailing Address - Fax:
Practice Address - Street 1:334 VALLEY LN
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2766
Practice Address - Country:US
Practice Address - Phone:419-301-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010305225XP0200X
OHOT008189225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics