Provider Demographics
NPI:1457696510
Name:COOKE, ELIZABETH CRAIG (OTL)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CRAIG
Last Name:COOKE
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 1:1201 GRAYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1514
Mailing Address - Country:US
Mailing Address - Phone:704-784-3437
Mailing Address - Fax:
Practice Address - Street 1:1201 GRAYSTONE CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1514
Practice Address - Country:US
Practice Address - Phone:704-784-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4037225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology