Provider Demographics
NPI:1376868216
Name:COCHO-TANNER, MELISSA D (OT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:COCHO-TANNER
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 1:814 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-7738
Mailing Address - Country:US
Mailing Address - Phone:803-804-0879
Mailing Address - Fax:
Practice Address - Street 1:1004 HARDIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-1609
Practice Address - Country:US
Practice Address - Phone:803-283-0987
Practice Address - Fax:803-283-0987
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist