Individual
AMY M COBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
152 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1569
(765) 463-2200
(765) 463-3625
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31000553A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000496763
ANTHEM
IN
05
—
201164450
—
IN
Enumeration date
10/16/2006
Last updated
02/13/2024
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