Provider Demographics
NPI:1750587929
Name:KOVACH, JOSEPH ROBERT (COTAL)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROBERT
Last Name:KOVACH
Suffix:
Gender:M
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43469-1155
Mailing Address - Country:US
Mailing Address - Phone:419-849-2788
Mailing Address - Fax:
Practice Address - Street 1:700 HELEN ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-2051
Practice Address - Country:US
Practice Address - Phone:419-547-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant