Provider Demographics
NPI:1134268477
Name:YOUNGLOVE-COOK, REBECCA KAY (OTR)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:KAY
Last Name:YOUNGLOVE-COOK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 KATZ RD
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9279
Mailing Address - Country:US
Mailing Address - Phone:517-522-5325
Mailing Address - Fax:
Practice Address - Street 1:5600 KATZ RD
Practice Address - Street 2:
Practice Address - City:GRASS LAKE
Practice Address - State:MI
Practice Address - Zip Code:49240-9279
Practice Address - Country:US
Practice Address - Phone:517-522-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist