Provider Demographics
NPI:1326008558
Name:COBB, MARSHA E (OT)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:E
Last Name:COBB
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3385
Mailing Address - Country:US
Mailing Address - Phone:770-962-4300
Mailing Address - Fax:770-339-7544
Practice Address - Street 1:758 OLD NORCROSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3385
Practice Address - Country:US
Practice Address - Phone:770-962-4300
Practice Address - Fax:770-339-7544
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003444A225X00000X
GAOT001155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000196970OtherANTHEM PROVIDER NUMBER
IN327503OtherPHCS PID NUMBER
INP00732745Medicare PIN
IN200336720Medicaid
IN815500S9Medicare PIN