Provider Demographics
NPI:1457476467
Name:COOLEY, CHANELLE ALIS (MOTRL)
Entity Type:Individual
Prefix:MRS
First Name:CHANELLE
Middle Name:ALIS
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:CHANELLE
Other - Middle Name:ALIS
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 MERCHANT CIR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-7204
Mailing Address - Country:US
Mailing Address - Phone:601-477-8788
Mailing Address - Fax:
Practice Address - Street 1:23 MASON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4437
Practice Address - Country:US
Practice Address - Phone:601-399-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1505225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand