Provider Demographics
NPI:1689227712
Name:COCHRANE, MONTEL S
Entity Type:Individual
Prefix:
First Name:MONTEL
Middle Name:S
Last Name:COCHRANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7057 WEST BLVD APT 147
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4322
Mailing Address - Country:US
Mailing Address - Phone:330-880-1137
Mailing Address - Fax:
Practice Address - Street 1:467 W HYLDA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2458
Practice Address - Country:US
Practice Address - Phone:330-999-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide