MEDICARE: MR. JONATHAN LEE COHEN MOT, OTR/L, SIPT

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
1	225XP0200X	Pediatric Occupational Therapist	0006886	FL
2	225X00000X	Occupational Therapist	112946	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255444923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN LEE COHEN MOT, OTR/L, SIPT

Provider Business Mailing Address
First Line	:	2708 BLACK SAGE DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3365
Country	:	US
Telephone Number	:	561-767-0082
Fax Number	:	972-559-1867

Provider Business Practice Location Address
First Line	:	12222 N CENTRAL EXPY
Second Line	:	SUITE 115
City	:	DALLAS
State	:	TX
Zip	:	75243-3720
Country	:	US
Telephone Number	:	972-546-0411
Fax Number	:	972-559-1867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	09/09/2010

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Directions to “ MR. JONATHAN LEE COHEN MOT, OTR/L, SIPT” Practice Location

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