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NPI Code Detail

MEDICARE: LACI N COCHRAN LMT

MEDICARE: LACI N COCHRAN LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist26060OR

General Provider Information

NPI Number : 1255038394
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACI N COCHRAN LMT
Provider Business Mailing Address
First Line : 5526 SE 60TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-5517
Country : US
Telephone Number : 425-354-0605
Fax Number :
Provider Business Practice Location Address
First Line : 4230 NE FREMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97213-1150
Country : US
Telephone Number : 503-208-5532
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2023
Last Update Date : 02/09/2023

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Directions to “ LACI N COCHRAN LMT” Practice Location

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