Provider Demographics
NPI:1669401006
Name:COOK, ANDREA MONIQUE (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MONIQUE
Last Name:COOK
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PYRITE CT
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-3151
Mailing Address - Country:US
Mailing Address - Phone:440-826-8051
Mailing Address - Fax:440-826-5930
Practice Address - Street 1:275 EASTLAND RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2005
Practice Address - Country:US
Practice Address - Phone:440-826-8051
Practice Address - Fax:440-826-5930
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0022412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer