Provider Demographics
NPI:1194813865
Name:COBB, ERIN BESHEAR (OTRL)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:BESHEAR
Last Name:COBB
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RAE
Other - Last Name:BESHEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:514 S BROWN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2948
Mailing Address - Country:US
Mailing Address - Phone:615-382-0500
Mailing Address - Fax:615-382-0501
Practice Address - Street 1:514 S BROWN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2937
Practice Address - Country:US
Practice Address - Phone:615-382-0500
Practice Address - Fax:615-382-0501
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3432225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514286Medicaid