Provider Demographics
NPI:1396967089
Name:KOSCH, SHANNON (OTR)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KOSCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 15TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-5127
Mailing Address - Country:US
Mailing Address - Phone:402-563-3718
Mailing Address - Fax:
Practice Address - Street 1:3005 19TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4248
Practice Address - Country:US
Practice Address - Phone:402-562-3341
Practice Address - Fax:402-564-0730
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist