Healthcare Provider Details

I. General information

NPI: 1467759696
Provider Name (Legal Business Name): MCCOOK THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 S. NEBRASKA
SALEM SD
57058
US

IV. Provider business mailing address

511 S. NEBRASKA
SALEM SD
57058
US

V. Phone/Fax

Practice location:
  • Phone: 605-421-1728
  • Fax: 605-425-9463
Mailing address:
  • Phone: 605-421-1728
  • Fax: 605-425-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number0119
License Number StateSD

VIII. Authorized Official

Name: AMY MARIE HEUMILLER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OT/L
Phone: 605-421-1728