Provider Demographics
NPI:1336804087
Name:COOK, MICHELLE (OTR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:ROHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3014 BROOKVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-8432
Mailing Address - Country:US
Mailing Address - Phone:402-570-7109
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-239-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2636225X00000X
KS17-04344225X00000X
AZOTH-009440225X00000X
IA117420225X00000X
WAOT61214067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist