Individual
AMANDA KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
215 TELLY RD, PICAYUNE, MS 39466-5363
(601) 799-4065
Mailing address
215 TELLY RD, PICAYUNE, MS 39466-5363
(601) 799-4065
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2062
MS
Other
Enumeration date
04/04/2008
Last updated
04/04/2008
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