Provider Demographics
NPI:1982722922
Name:MALACARNE- COOKE, MADONNA MARIAN (COTA)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:MARIAN
Last Name:MALACARNE- COOKE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E HWY K
Mailing Address - Street 2:PO BOX 128
Mailing Address - City:LADDONIA
Mailing Address - State:MO
Mailing Address - Zip Code:63352-0128
Mailing Address - Country:US
Mailing Address - Phone:407-529-4862
Mailing Address - Fax:
Practice Address - Street 1:1509 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4568
Practice Address - Country:US
Practice Address - Phone:360-736-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00001225224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant