Individual
MS. DAVITA J COOK
Active
Individual
MS. DAVITA J COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
1003588732
OH
156F00000X
Technician/Technologist
6009038
NY
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
1003588732
OH
291U00000X
Clinical Medical Laboratory
Primary
1003588732
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0287258
—
OH
01
—
1003588732
CLIA
OH
Enumeration date
09/30/2021
Last updated
02/22/2022
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