Provider Demographics
NPI:1487869459
Name:COCHRAN, VINCENT B (OTR-L)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:B
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7299 E CLIFF ROSE TRL
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218-1931
Mailing Address - Country:US
Mailing Address - Phone:480-981-0763
Mailing Address - Fax:480-981-0763
Practice Address - Street 1:3130 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-1740
Practice Address - Country:US
Practice Address - Phone:480-396-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3740225X00000X
OHOT-006111225X00000X
KYKY-R3005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist