Provider Demographics
NPI:1518080423
Name:COCHRANE, KELLI SUE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:SUE
Last Name:COCHRANE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STONE GATE CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9665
Mailing Address - Country:US
Mailing Address - Phone:912-257-8707
Mailing Address - Fax:
Practice Address - Street 1:815 E 63RD ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4420
Practice Address - Country:US
Practice Address - Phone:912-352-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist