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General NPI Number Information
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NPI Number | 1689972358
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Entity Type | Organization
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Legal Business Name | COOK THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 2970 POSSUM TROT RD # 2
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City | LEBURN
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State | KY
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Zip | 41831-8950
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Country | US
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Telephone | 606-497-7533
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Fax | 606-785-5441
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Provider Business Mailing Address
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Address Line | PO BOX 212
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City | MOUSIE
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State | KY
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Zip | 41839-0212
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Country | US
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Telephone | 606-497-7533
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Fax | 606-785-5441
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. AMANDA R BLACKBURN-COOK
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Credential | MA, CCC/SLP
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Telephone | 606-497-7533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 3571
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License Number State | KY
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