Provider Demographics
NPI:1043994924
Name:COCHRAN, COOPER MAXWELL (DOT)
Entity type:Individual
Prefix:
First Name:COOPER
Middle Name:MAXWELL
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DOT
Other - Prefix:
Other - First Name:COOPER
Other - Middle Name:MAXWELL
Other - Last Name:GROTKOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1730 SE MILE HILL DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3512
Mailing Address - Country:US
Mailing Address - Phone:360-287-4662
Mailing Address - Fax:
Practice Address - Street 1:1730 SE MILE HILL DR UNIT 100
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3512
Practice Address - Country:US
Practice Address - Phone:360-287-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist