Provider Demographics
NPI:1902499700
Name:COOK, REBECCA SARI (MSPO, CP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SARI
Last Name:COOK
Suffix:
Gender:F
Credentials:MSPO, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SPRINGBROOK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-8520
Mailing Address - Country:US
Mailing Address - Phone:919-585-4173
Mailing Address - Fax:919-879-8248
Practice Address - Street 1:166 SPRINGBROOK AVE STE 203
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8520
Practice Address - Country:US
Practice Address - Phone:919-585-4173
Practice Address - Fax:919-879-8248
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP004444224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist