Healthcare Provider Details

I. General information

NPI: 1790607315
Provider Name (Legal Business Name): CHAYA COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAIA COHEN

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17040 W GREENFIELD AVE STE 6
BROOKFIELD WI
53005-6844
US

IV. Provider business mailing address

3290 N 50TH ST
MILWAUKEE WI
53216-3212
US

V. Phone/Fax

Practice location:
  • Phone: 262-439-8019
  • Fax:
Mailing address:
  • Phone: 845-729-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14544-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: