Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT004100 | GA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTOO4100 | GA |
NPI | 1023231768 |
---|---|
Provider Name | Ms. Sheelah Lynne Koch-Cochran |
First Address | Marietta, GA 30066-2468 |
Second Address | Atlanta, GA 30342-1654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 25/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
878844045A | (05) | GA |