Provider Demographics
NPI:1215138151
Name:COCHRAN, NICOLE MYA (ATC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MYA
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 SILVER BOW DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9122
Mailing Address - Country:US
Mailing Address - Phone:614-876-4235
Mailing Address - Fax:
Practice Address - Street 1:70 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1397
Practice Address - Country:US
Practice Address - Phone:614-839-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0007372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer