Provider Demographics
NPI:1518365436
Name:COOK, SHIRLEY LENEVA (LMT, RDH)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LENEVA
Last Name:COOK
Suffix:
Gender:F
Credentials:LMT, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BORLAND RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-9758
Mailing Address - Country:US
Mailing Address - Phone:810-614-6903
Mailing Address - Fax:
Practice Address - Street 1:92 W NEPESSING ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2144
Practice Address - Country:US
Practice Address - Phone:810-664-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL572430225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist