Individual
MS. TRACEY E KOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ITDS
Contact information
Practice address
21113 LAKE TALIA BLVD, LAND O LAKES, FL 34638-3738
(813) 873-1936
(813) 873-8837
Mailing address
21113 LAKE TALIA BLVD, LAND O LAKES, FL 34638-3738
(813) 873-1936
(813) 873-8837
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
007369
SC
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
06/18/2012
Last updated
06/18/2012
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