Provider Demographics
NPI:1285141275
Name:COCHRAN, MELISSA (ATC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:346 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9778
Mailing Address - Country:US
Mailing Address - Phone:509-332-9147
Mailing Address - Fax:
Practice Address - Street 1:1410 E CLEVELAND STREET
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-8384
Practice Address - Country:US
Practice Address - Phone:509-332-9147
Practice Address - Fax:509-332-9147
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-602235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist