Healthcare Provider Details

I. General information

NPI: 1265625438
Provider Name (Legal Business Name): BENITRA COOK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 HOOD RD NE
MARIETTA GA
30068-2290
US

IV. Provider business mailing address

PO BOX 901
SMITHS AL
36877-0901
US

V. Phone/Fax

Practice location:
  • Phone: 770-565-8828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT005931
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2892
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: