Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 5201000051 | MI |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201000051 | MI |
NPI | 1255769188 |
---|---|
Provider Name | Julie Jordan Cook |
First Address | Detroit, MI 48267-4779 |
Second Address | Traverse City, MI 49686-3464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2013 |
Last Update Date | 05/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255769188 | (05) | MI |