Provider Demographics
NPI:1033322193
Name:COOK, KARLA LYNN (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-716-6140
Mailing Address - Fax:864-716-6149
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 3950
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-716-6140
Practice Address - Fax:864-716-6149
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH3454Medicaid