Provider Demographics
NPI:1124147681
Name:NELSON-COOK, TAMMY MARIE (LPTA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:NELSON-COOK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 LAFAYETTE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4735
Mailing Address - Country:US
Mailing Address - Phone:508-843-2308
Mailing Address - Fax:
Practice Address - Street 1:90 LINDALL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2125
Practice Address - Country:US
Practice Address - Phone:978-777-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2907225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant