Provider Demographics
NPI:1891904025
Name:COCHRAN, KIMBERLY ANN (OTL)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 SIDNEY BAKER ST S
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5915
Mailing Address - Country:US
Mailing Address - Phone:830-896-3130
Mailing Address - Fax:830-896-3132
Practice Address - Street 1:448 SIDNEY BAKER ST S
Practice Address - Street 2:SUITE 103
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5915
Practice Address - Country:US
Practice Address - Phone:830-896-3130
Practice Address - Fax:830-896-3132
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107205225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics