Healthcare Provider Details

I. General information

NPI: 1194487181
Provider Name (Legal Business Name): BRA'DON COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1586 WILSON AVE
COLUMBUS OH
43207-1359
US

IV. Provider business mailing address

1586 WILSON AVE
COLUMBUS OH
43207-1359
US

V. Phone/Fax

Practice location:
  • Phone: 765-437-6431
  • Fax:
Mailing address:
  • Phone: 765-437-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: