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General NPI Number Information
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NPI Number | 1154550291
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Entity Type | Individual
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Provider Name | MARISA LYNN COOK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 01/16/2022
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Provider Practice Location Address
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Address Line | 804 US HIGHWAY 1 STE 8
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City | LAKE PARK
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State | FL
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Zip | 33403-2940
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Country | US
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Telephone | 561-429-6018
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Fax |
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Provider Business Mailing Address
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Address Line | 253 E KALMIA DR
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City | LAKE PARK
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State | FL
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Zip | 33403-2718
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Country | US
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Telephone | 772-631-8216
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT12007
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License Number State | FL
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