Provider Demographics
NPI:1255444923
Name:COHEN, JONATHAN LEE (MOT, OTR/L, SIPT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LEE
Last Name:COHEN
Suffix:
Gender:M
Credentials:MOT, OTR/L, SIPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 BLACK SAGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3365
Mailing Address - Country:US
Mailing Address - Phone:561-767-0082
Mailing Address - Fax:972-559-1867
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3720
Practice Address - Country:US
Practice Address - Phone:972-546-0411
Practice Address - Fax:972-559-1867
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0006886225XP0200X
TX112946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884440200Medicaid