Provider Demographics
NPI:1073189767
Name:COOK, DANIELLE MAE (ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MAE
Last Name:COOK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:NY
Mailing Address - Zip Code:12917-2339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:NY
Practice Address - Zip Code:12917-2339
Practice Address - Country:US
Practice Address - Phone:518-497-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0077162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY380277697OtherMVP
NY82113300803OtherMVP