Provider Demographics
NPI:1639285588
Name:COCKRIEL, DANA RAE (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:RAE
Last Name:COCKRIEL
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 HALEY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-8800
Mailing Address - Country:US
Mailing Address - Phone:843-425-3627
Mailing Address - Fax:843-797-6675
Practice Address - Street 1:8505 HALEY CT
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-8800
Practice Address - Country:US
Practice Address - Phone:843-425-3627
Practice Address - Fax:843-797-6675
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3183225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1790Medicaid
SCQ34275Medicare PIN