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General NPI Number Information
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NPI Number | 1073219333
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Entity Type | Individual
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Provider Name | KEVIN D COOK LMT
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Gender | Male
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 4269 ST FRANCIS DR LOCATED IN BUKATY FAMILY CHIROPRACTIC
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City | HAMBURG
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State | NY
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Zip | 14075-1724
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Country | US
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Telephone | 716-422-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 239 W MAIN ST
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City | GOWANDA
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State | NY
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Zip | 14070-1330
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Country | US
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Telephone | 716-367-7460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 031877
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License Number State | NY
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