Provider Demographics
NPI:1881230142
Name:COOK, ANGELA DULAC (CCMP, CRANIO THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DULAC
Last Name:COOK
Suffix:
Gender:F
Credentials:CCMP, CRANIO THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:KEENE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12943-0466
Mailing Address - Country:US
Mailing Address - Phone:518-524-5472
Mailing Address - Fax:
Practice Address - Street 1:41 SAINT BERNARD ST
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1834
Practice Address - Country:US
Practice Address - Phone:518-524-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028980-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist