Provider Demographics
NPI:1710461496
Name:COOKE, BRIANNA JOY (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:JOY
Last Name:COOKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:JOY
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2410 VINTAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3835
Mailing Address - Country:US
Mailing Address - Phone:484-695-3411
Mailing Address - Fax:
Practice Address - Street 1:2410 VINTAGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3835
Practice Address - Country:US
Practice Address - Phone:484-695-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005665225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist