Provider Demographics
NPI:1407385016
Name:COOK, CAMERON JAMES (LMP)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:JAMES
Last Name:COOK
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5243
Mailing Address - Country:US
Mailing Address - Phone:509-884-7163
Mailing Address - Fax:509-884-2363
Practice Address - Street 1:1120 GRANT RD
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5243
Practice Address - Country:US
Practice Address - Phone:509-884-7163
Practice Address - Fax:509-884-2363
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60677401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist