Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119006629 | VA |
N | 225X00000X | Occupational Therapist | 31004275A | IN |
N | 225XH1200X | Occupational Therapist - Hand | 31004275A | IN |
NPI | 1003912536 |
---|---|
Provider Name | Barbara Liesbeth Cook |
First Address | North Chesterfield, VA 23225-4067 |
Second Address | Indianapolis, IN 46260-2046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 01/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000388066 | ANTHEM HEALTH PLAN (01) | |
200809530 | (05) | IN |