Provider Demographics
NPI:1922668318
Name:KOCENT, MICHELE L
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:L
Last Name:KOCENT
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 1:390 PILOTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-6752
Mailing Address - Country:US
Mailing Address - Phone:802-598-6900
Mailing Address - Fax:
Practice Address - Street 1:950 48TH AVE N STE 203
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5434
Practice Address - Country:US
Practice Address - Phone:843-438-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0661237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHAS-0661OtherLICENSE NUMBER