Provider Demographics
NPI:1619183670
Name:COOK, MARY E (LMT,LAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:LMT,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MADISON AVE N
Mailing Address - Street 2:SUITE D
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1749
Mailing Address - Country:US
Mailing Address - Phone:206-842-7706
Mailing Address - Fax:
Practice Address - Street 1:533 MADISON AVE N
Practice Address - Street 2:SUITE D
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1749
Practice Address - Country:US
Practice Address - Phone:206-842-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002969171100000X
WAMC00005579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist