Provider Demographics
NPI:1316349640
Name:KOCH, ROSE SARA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:SARA
Last Name:KOCH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:SARA
Other - Last Name:PILLATZKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3018 W RAPID ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8173
Mailing Address - Country:US
Mailing Address - Phone:605-595-5909
Mailing Address - Fax:
Practice Address - Street 1:949 HARMON ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2452
Practice Address - Country:US
Practice Address - Phone:605-720-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0924225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist