Healthcare Provider Details

I. General information

NPI: 1073219333
Provider Name (Legal Business Name): KEVIN D COOK LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S WATER ST
GOWANDA NY
14070-1415
US

IV. Provider business mailing address

239 W MAIN ST
GOWANDA NY
14070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 716-422-0288
  • Fax: 716-412-9003
Mailing address:
  • Phone: 716-367-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: