Provider Demographics
NPI:1891068839
Name:COOK, KALIA LARICINA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KALIA
Middle Name:LARICINA
Last Name:COOK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 HOMER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3330
Mailing Address - Country:US
Mailing Address - Phone:907-345-0050
Mailing Address - Fax:
Practice Address - Street 1:8200 HOMER DR
Practice Address - Street 2:SUITE E
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3330
Practice Address - Country:US
Practice Address - Phone:907-345-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2406225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist