Individual
BONNIE DE LANE KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
13420 W SAN PABLO DR, SUN CITY WEST, AZ 85375-6818
(719) 237-2649
Mailing address
13420 W SAN PABLO DR, SUN CITY WEST, AZ 85375-6818
(719) 237-2649
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
1054
CO
225XP0200X
Pediatric Occupational Therapist
1081
HI
225XP0200X
Pediatric Occupational Therapist
Primary
5116
AZ
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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