Provider Demographics
NPI:1871549097
Name:COCHRAN, CRYSTAL DAWN (ATC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 DEMILO PL
Mailing Address - Street 2:APT. #312
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6686
Mailing Address - Country:US
Mailing Address - Phone:217-821-9165
Mailing Address - Fax:
Practice Address - Street 1:10513 DEMILO PL
Practice Address - Street 2:APT. #312
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6686
Practice Address - Country:US
Practice Address - Phone:217-821-9165
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 18102255A2300X
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer