Provider Demographics
NPI:1811500986
Name:KOCH, MEREDITH MICHELE
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MICHELE
Last Name:KOCH
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:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:WV
Mailing Address - Zip Code:25652-0098
Mailing Address - Country:US
Mailing Address - Phone:304-687-0201
Mailing Address - Fax:
Practice Address - Street 1:51 GATEWAY ROAD
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:WV
Practice Address - Zip Code:25652
Practice Address - Country:US
Practice Address - Phone:304-687-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant