Provider Demographics
NPI:1205926912
Name:COOK, STACY V (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:V
Last Name:COOK
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23586 CALABASAS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1319
Mailing Address - Country:US
Mailing Address - Phone:818-224-3837
Mailing Address - Fax:818-224-3847
Practice Address - Street 1:23586 CALABASAS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1319
Practice Address - Country:US
Practice Address - Phone:818-224-3837
Practice Address - Fax:818-224-3847
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X, 225XE1200X, 225XN1300X
CA4803225X00000X
CA9611000317225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4803OtherCBOT
915259OtherNBCOT
CA9611000317OtherCHT LICENSE
915259OtherNBCOT