MEDICARE: CARI LEIGH COOKE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2414	AZ

General Provider Information

NPI Number	:	1023345527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARI LEIGH COOKE OTR/L

Provider Business Mailing Address
First Line	:	5401 E VAN BUREN ST
Second Line	:	3028
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3497
Country	:	US
Telephone Number	:	480-686-1497
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 E VAN BUREN ST
Second Line	:	3028
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3497
Country	:	US
Telephone Number	:	480-686-1497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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