Provider Demographics
NPI:1043868540
Name:COOKE, CLAYTON JOSEPH (MT-BC)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:JOSEPH
Last Name:COOKE
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 DELOREAN PL APT 304
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6688
Mailing Address - Country:US
Mailing Address - Phone:910-584-5281
Mailing Address - Fax:
Practice Address - Street 1:166 DELOREAN PL APT 304
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6688
Practice Address - Country:US
Practice Address - Phone:910-584-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13448225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist