Individual
MRS. KELLY DIANA KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, MOTR/L
Contact information
Practice address
11143 S. TROY, CHICAGO, IL 60655
(773) 621-4868
Mailing address
11143 S. TROY, CHICAGO, IL 60655
(773) 621-4868
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.008959
IL
Other
Enumeration date
12/12/2011
Last updated
12/12/2011
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