Provider Demographics
NPI:1750779062
Name:COOK, SAMANTHA (MAC, LICAC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MAC, LICAC
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 1516
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-1516
Mailing Address - Country:US
Mailing Address - Phone:802-477-2577
Mailing Address - Fax:
Practice Address - Street 1:31 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-477-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist