Provider Demographics
NPI:1063060135
Name:COOK, CLINT (OTD, OTR/L, CLT-UE)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:OTD, OTR/L, CLT-UE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13047 KING CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5258
Mailing Address - Country:US
Mailing Address - Phone:720-383-2457
Mailing Address - Fax:
Practice Address - Street 1:4740 PEARL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3080
Practice Address - Country:US
Practice Address - Phone:303-442-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist