Provider Demographics
NPI:1992151898
Name:COCHRAN, MONICA (LMT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 KENSINGTON PKWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2943
Mailing Address - Country:US
Mailing Address - Phone:240-833-2075
Mailing Address - Fax:240-833-2076
Practice Address - Street 1:10410 KENSINGTON PKWY
Practice Address - Street 2:SUITE 10
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2943
Practice Address - Country:US
Practice Address - Phone:240-833-2075
Practice Address - Fax:240-833-2076
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05559225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist