Provider Demographics
NPI:1265888960
Name:COSHOW, CADY (ATC, LAT, MED)
Entity type:Individual
Prefix:
First Name:CADY
Middle Name:
Last Name:COSHOW
Suffix:
Gender:F
Credentials:ATC, LAT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W ELM AVE
Mailing Address - Street 2:APT 219
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 W ELM AVE
Practice Address - Street 2:APT 219
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3300
Practice Address - Country:US
Practice Address - Phone:972-658-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer