Provider Demographics
NPI:1851415269
Name:COOK, STACY E (LOT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:17774 CYPRESS ROSEHILL RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7815
Mailing Address - Country:US
Mailing Address - Phone:832-792-9399
Mailing Address - Fax:832-210-1894
Practice Address - Street 1:17774 CYPRESS ROSEHILL RD STE 320
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7815
Practice Address - Country:US
Practice Address - Phone:832-792-9399
Practice Address - Fax:832-210-1894
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110607225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179495001Medicaid