Provider Demographics
NPI:1043864929
Name:COOKLIN, SANDRA LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:COOKLIN
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 1:6302 DUSENBURG RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1525
Mailing Address - Country:US
Mailing Address - Phone:440-668-0557
Mailing Address - Fax:
Practice Address - Street 1:6302 DUSENBURG RD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1525
Practice Address - Country:US
Practice Address - Phone:440-668-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19680225X00000X
OH000977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist