Healthcare Provider Details

I. General information

NPI: 1891160677
Provider Name (Legal Business Name): NATALIE L COOKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 GRAND CENTRAL AVE
VIENNA WV
26105-1081
US

IV. Provider business mailing address

1605 GRAND CENTRAL AVE
VIENNA WV
26105-1081
US

V. Phone/Fax

Practice location:
  • Phone: 304-295-7290
  • Fax: 304-295-5922
Mailing address:
  • Phone: 304-295-7290
  • Fax: 304-295-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CAROLE G FORTNEY
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 740-525-7660