Provider Demographics
NPI:1174288351
Name:COOK, CLARA
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
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 1:1471 OLDE KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-4755
Mailing Address - Country:US
Mailing Address - Phone:704-726-7491
Mailing Address - Fax:
Practice Address - Street 1:1471 OLDE KENSINGTON LN
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-4755
Practice Address - Country:US
Practice Address - Phone:704-726-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS12138225700000X
NC16504225700000X
FLMA97292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist