Provider Demographics
NPI:1134170715
Name:COOPER, NATALIE COOKE (OTL)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:COOKE
Last Name:COOPER
Suffix:
Gender:F
Credentials:OTL
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 2496
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-2496
Mailing Address - Country:US
Mailing Address - Phone:828-773-8477
Mailing Address - Fax:877-384-7096
Practice Address - Street 1:207 WINKLERS CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-773-8477
Practice Address - Fax:877-384-7096
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3076225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC193230OtherMEDCOST
NC138A9OtherBCBS OF NC PROVIDER NUMBE
NC7301675Medicaid