Provider Demographics
NPI:1598014847
Name:MOOK, MICHELLE ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:MOOK
Suffix:
Gender:F
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 1:20110 W 224TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-7403
Mailing Address - Country:US
Mailing Address - Phone:913-707-6131
Mailing Address - Fax:
Practice Address - Street 1:1100 W 15TH ST
Practice Address - Street 2:OTTAWA RETIREMENT VILLAGE
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067
Practice Address - Country:US
Practice Address - Phone:785-242-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01633172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker