Provider Demographics
NPI:1215351341
Name:COOK, JULIE ANN
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NOLAN PKWY
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-8404
Mailing Address - Country:US
Mailing Address - Phone:567-444-4800
Mailing Address - Fax:
Practice Address - Street 1:205 NOLAN PARKWAY
Practice Address - Street 2:NORTHWEST OHIO EDUCATIONAL SERVICE CENTER
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502
Practice Address - Country:US
Practice Address - Phone:567-444-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02442224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant