Provider Demographics
NPI:1750972485
Name:COCHRAN-SCANDRICK, AMBER HAILEY (17500000X)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:HAILEY
Last Name:COCHRAN-SCANDRICK
Suffix:
Gender:F
Credentials:17500000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MURRAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-7614
Mailing Address - Country:US
Mailing Address - Phone:937-204-8196
Mailing Address - Fax:
Practice Address - Street 1:625 MURRAY HILL DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-7614
Practice Address - Country:US
Practice Address - Phone:937-204-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0008162175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist