Individual
MISS STACI JO COUCHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3919 HOPE LN, ERLANGER, KY 41018-1667
(765) 894-0838
Mailing address
1849 TILDEN AVE, NORWOOD, OH 45212-2517
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005165
OH
224Z00000X
Occupational Therapy Assistant
A5827
KY
Other
Enumeration date
09/29/2017
Last updated
09/29/2017
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