MEDICARE: MS. JENINE COOK OTR-L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0113	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093853111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENINE COOK OTR-L

Provider Business Mailing Address
First Line	:	601 W BELMONT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7262
Country	:	US
Telephone Number	:	602-216-9475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 E GUADALUPE RD
Second Line	:	STE 103
City	:	TEMPE
State	:	AZ
Zip	:	85283-3277
Country	:	US
Telephone Number	:	480-456-0942
Fax Number	:	480-456-0956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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