Provider Demographics
NPI:1508317603
Name:COOKE, DATY H
Entity Type:Individual
Prefix:
First Name:DATY
Middle Name:H
Last Name:COOKE
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 1:2 CAROLINE CV
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-6602
Mailing Address - Country:US
Mailing Address - Phone:662-822-4500
Mailing Address - Fax:662-843-5401
Practice Address - Street 1:4036 HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-8551
Practice Address - Country:US
Practice Address - Phone:662-843-4014
Practice Address - Fax:662-843-5401
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist