Provider Demographics
NPI:1700162112
Name:GOOKIN, CECELIA JEANNE (MS OTR)
Entity Type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:JEANNE
Last Name:GOOKIN
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GANSEVOORT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-5209
Mailing Address - Country:US
Mailing Address - Phone:518-338-3176
Mailing Address - Fax:
Practice Address - Street 1:1979 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4501
Practice Address - Country:US
Practice Address - Phone:518-464-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004104-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist