MEDICARE: MRS. STEPHANIE LYNN COHEN RD, LD

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	133V00000X	Registered Dietitian	DT80995	TX

General Provider Information

NPI Number	:	1538424254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE LYNN COHEN RD, LD

Provider Business Mailing Address
First Line	:	400 AUSTIN ACRES
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-5091
Country	:	US
Telephone Number	:	713-504-1278
Fax Number	:

Provider Business Practice Location Address
First Line	:	3506 FARM ROAD 1402
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-7406
Country	:	US
Telephone Number	:	903-572-5427
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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