Provider Demographics
NPI:1174354047
Name:UPSTATE OT
Entity type:Organization
Organization Name:UPSTATE OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:518-791-7469
Mailing Address - Street 1:12 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4655
Mailing Address - Country:US
Mailing Address - Phone:518-791-7469
Mailing Address - Fax:
Practice Address - Street 1:92 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4489
Practice Address - Country:US
Practice Address - Phone:518-791-7469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center