Basic Information
| Provider Information | |||||||||
| NPI: | 1922211168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOCH | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 236 CENTAURIAN DR | ||||||||
| Address2: | |||||||||
| City: | WEST BERLIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080913821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567530894 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2150 ROUTE 38 | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080024302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566674550 | ||||||||
| FaxNumber: | 8566673507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 46TA09052800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.