Healthcare Provider Details

I. General information

NPI: 1356863674
Provider Name (Legal Business Name): STEPHANIE CORBITT COOK OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UNIVERSITY PKWY STE 104
PENSACOLA FL
32514-5485
US

IV. Provider business mailing address

9400 UNIVERSITY PKWY STE 104
PENSACOLA FL
32514-5485
US

V. Phone/Fax

Practice location:
  • Phone: 850-208-6120
  • Fax: 850-208-6129
Mailing address:
  • Phone: 850-208-6120
  • Fax: 850-208-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number8728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: