Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 6229 | NC |
NPI | 1013268440 |
---|---|
Provider Name | Mrs. Mary-Lou Elizabeth Cook |
First Address | Leland, NC 28451-7792 |
Second Address | Leland, NC 28451-7792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 25/09/2012 |