Basic Information
| Provider Information | |||||||||
| NPI: | 1487037495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | MARIAN | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2215 | ||||||||
| Address2: | 257 EAST MAIN STREET | ||||||||
| City: | OLD FORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286681711 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 611 OLD US HWY 70E | ||||||||
| Address2: | MOUNTAIN RIDGE SKILLED NURSING | ||||||||
| City: | BLACK MTN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286699991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 07/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1765 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.