Healthcare Provider Details

I. General information

NPI: 1518476381
Provider Name (Legal Business Name): ERIN DREW COOK OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date: 01/19/2021
Deactivation Date: 04/11/2018
Reactivation Date: 01/13/2021

III. Provider practice location address

2818 TRAMWAY CIR NE
ALBUQUERQUE NM
87122-2239
US

IV. Provider business mailing address

2818 TRAMWAY CIR NE
ALBUQUERQUE NM
87122-2239
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-1125
  • Fax:
Mailing address:
  • Phone: 505-573-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number14278
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: