Healthcare Provider Details

I. General information

NPI: 1982252003
Provider Name (Legal Business Name): KELLI COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DAWN DR
CORTLAND NY
13045-3108
US

IV. Provider business mailing address

12 DAWN DR
CORTLAND NY
13045-3108
US

V. Phone/Fax

Practice location:
  • Phone: 607-283-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number023868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: