Provider Demographics
NPI:1679721278
Name:COOK, MICHELLE A (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437
Mailing Address - Country:US
Mailing Address - Phone:585-335-4040
Mailing Address - Fax:
Practice Address - Street 1:590 FISHERS STATION DR
Practice Address - Street 2:SUITE 130
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9744
Practice Address - Country:US
Practice Address - Phone:585-924-7207
Practice Address - Fax:585-924-7049
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012191-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-0213081OtherTAX ID