Provider Demographics
NPI:1023231768
Name:KOCH-COCHRAN, SHEELAH LYNNE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:SHEELAH
Middle Name:LYNNE
Last Name:KOCH-COCHRAN
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 1:4197 LONG BRANCH DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2468
Mailing Address - Country:US
Mailing Address - Phone:404-785-3781
Mailing Address - Fax:404-785-3769
Practice Address - Street 1:5455 MERIDIAN MARKS RD NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1654
Practice Address - Country:US
Practice Address - Phone:404-785-3781
Practice Address - Fax:404-785-3769
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTOO4100225XP0200X
GAOT004100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA878844045AMedicaid