Provider Demographics
NPI:1285385724
Name:COOK, ALYSSA (COTA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N FOREST LN
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-6828
Mailing Address - Country:US
Mailing Address - Phone:812-605-2734
Mailing Address - Fax:
Practice Address - Street 1:503 S MURPHY AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-8391
Practice Address - Country:US
Practice Address - Phone:812-446-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant