Healthcare Provider Details

I. General information

NPI: 1285132324
Provider Name (Legal Business Name): SETH COCHRILL CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 W. 96TH ST.
INDIANAPOLIS IN
46268
US

IV. Provider business mailing address

3445 W 96TH ST
INDIANAPOLIS IN
46268-1102
US

V. Phone/Fax

Practice location:
  • Phone: 317-334-1114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: