Provider Demographics
NPI:1861748303
Name:KOTSCH, COURTNEY AMANDA
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:AMANDA
Last Name:KOTSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1858
Mailing Address - Country:US
Mailing Address - Phone:815-661-1902
Mailing Address - Fax:
Practice Address - Street 1:1048 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1858
Practice Address - Country:US
Practice Address - Phone:815-661-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist