Basic Information
| Provider Information | |||||||||
| NPI: | 1598014847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOOK | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20110 W 224TH ST | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660837403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137076131 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 W 15TH ST | ||||||||
| Address2: | OTTAWA RETIREMENT VILLAGE | ||||||||
| City: | OTTAWA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852425399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 08/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | 17-01633 | KS | Y | Other Service Providers | Community Health Worker |
No ID Information.