Provider Demographics
NPI:1194860080
Name:COCKS, MARY DOLORES
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DOLORES
Last Name:COCKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 HAMILTON CR.
Mailing Address - Street 2:#206B
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:321-720-3059
Mailing Address - Fax:386-671-9271
Practice Address - Street 1:11000 HAMILTON CR.
Practice Address - Street 2:206B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:321-720-3059
Practice Address - Fax:386-671-9271
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist