Provider Demographics
NPI:1528827532
Name:KOCH, AMANDA GRETTIE (MT-BC, WMTR)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRETTIE
Last Name:KOCH
Suffix:
Gender:F
Credentials:MT-BC, WMTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W60N319 HILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2401
Mailing Address - Country:US
Mailing Address - Phone:262-573-7367
Mailing Address - Fax:
Practice Address - Street 1:1125 JAMES DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-8367
Practice Address - Country:US
Practice Address - Phone:262-637-6663
Practice Address - Fax:262-367-3056
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist