Provider Demographics
NPI:1396968244
Name:COCKETT, SHILOH (LMP)
Entity type:Individual
Prefix:MR
First Name:SHILOH
Middle Name:
Last Name:COCKETT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 222ND ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8152
Mailing Address - Country:US
Mailing Address - Phone:425-508-1914
Mailing Address - Fax:
Practice Address - Street 1:6823 OSWEGO PL NE
Practice Address - Street 2:SUITE #1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8415
Practice Address - Country:US
Practice Address - Phone:206-527-9709
Practice Address - Fax:206-526-2991
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013705174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist