Provider Demographics
NPI:1497803944
Name:COOK, ANTONIO DESHUN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:DESHUN
Last Name:COOK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3384 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-9442
Mailing Address - Country:US
Mailing Address - Phone:662-871-2080
Mailing Address - Fax:
Practice Address - Street 1:3384 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-9442
Practice Address - Country:US
Practice Address - Phone:662-871-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2248225X00000X
MSPTA3621225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant