Provider Demographics
NPI:1639360415
Name:COCHRAN, KEESHA ELISE
Entity Type:Individual
Prefix:
First Name:KEESHA
Middle Name:ELISE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 S ASSEMBLY RD
Mailing Address - Street 2:APT. 75
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5062
Mailing Address - Country:US
Mailing Address - Phone:509-280-3886
Mailing Address - Fax:
Practice Address - Street 1:2808 S ASSEMBLY RD
Practice Address - Street 2:APT. 75
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5062
Practice Address - Country:US
Practice Address - Phone:509-280-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist