Provider Demographics
NPI:1689867756
Name:COHEN, ORLY (CERTIFIED PEDORTHIST)
Entity Type:Individual
Prefix:MRS
First Name:ORLY
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 HIGHWAY 70 S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2981
Mailing Address - Country:US
Mailing Address - Phone:615-662-1300
Mailing Address - Fax:615-662-1326
Practice Address - Street 1:7114 HIGHWAY 70 S
Practice Address - Street 2:SUITE 109
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2981
Practice Address - Country:US
Practice Address - Phone:615-662-1300
Practice Address - Fax:615-662-1326
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455047Medicaid