Basic Information
| Provider Information | |||||||||
| NPI: | 1083872345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOCSIS | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | RONALD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | PROVIDENCE ST. MARY MEDICAL CENTER 401 W. POPLAR ST. | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098972100 | ||||||||
| FaxNumber: | 5098975508 | ||||||||
| Practice Location | |||||||||
| Address1: | PROVIDENCE ST. MARY MEDICAL CENTER 401 W. POPLAR ST. | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993624619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098972100 | ||||||||
| FaxNumber: | 5098975508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 113371 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OT-498 | ID | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OT00002963 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.