Provider Demographics
NPI:1063860732
Name:COBB, BRIAN (MSOT R/L)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:COBB
Suffix:
Gender:M
Credentials:MSOT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12907 BRISTOL BERRY DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3824
Mailing Address - Country:US
Mailing Address - Phone:832-693-1814
Mailing Address - Fax:
Practice Address - Street 1:611 E HAMPTON ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-2814
Practice Address - Country:US
Practice Address - Phone:864-226-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOT .4738 OT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist