Healthcare Provider Details

I. General information

NPI: 1891904025
Provider Name (Legal Business Name): KIMBERLY ANN COCHRAN OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SIDNEY BAKER ST S SUITE 103
KERRVILLE TX
78028-5915
US

IV. Provider business mailing address

448 SIDNEY BAKER ST S
KERRVILLE TX
78028-5915
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-3130
  • Fax: 830-896-3132
Mailing address:
  • Phone: 830-896-3130
  • Fax: 830-896-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number107205
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: