=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659573368
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERA JEAN COOK OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HINES VA HOSPITAL
-----------------------------------------------------
City | HINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-202-2285
-----------------------------------------------------
Fax | 708-202-2281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 945 SEMINOLE DR APT. #6
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60120-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-505-5331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------