MEDICARE: BECKI LYNNE COHILL OTD OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT.0002327	CO

General Provider Information

NPI Number	:	1295144277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKI LYNNE COHILL OTD OTR/L

Provider Business Mailing Address
First Line	:	22771 COUNTY ROAD G
Second Line	:
City	:	SUGAR CITY
State	:	CO
Zip	:	81076-9511
Country	:	US
Telephone Number	:	719-671-1793
Fax Number	:

Provider Business Practice Location Address
First Line	:	22771 COUNTY ROAD G
Second Line	:
City	:	SUGAR CITY
State	:	CO
Zip	:	81076-9511
Country	:	US
Telephone Number	:	719-671-1793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	02/04/2019

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