Provider Demographics
NPI:1326008558
Name:COBB, MARSHA E (OT)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:E
Last Name:COBB
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-358-6115
Mailing Address - Fax:803-794-5960
Practice Address - Street 1:811 W MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2500
Practice Address - Country:US
Practice Address - Phone:803-358-6115
Practice Address - Fax:803-358-6117
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001155225X00000X
IN31003444A225X00000X
SC7078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000196970OtherANTHEM PROVIDER NUMBER
IN327503OtherPHCS PID NUMBER
INP00732745Medicare PIN
IN200336720Medicaid
IN815500S9Medicare PIN