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Individual

MR. KENNETH J. COOK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OTA/L

Contact information

Practice address
8211 W USTICK RD, BOISE, ID 83704-5756
(208) 375-3700
(208) 375-3760
Mailing address
3746 N TIPTON PL, MERIDIAN, ID 83646-6309
(208) 484-5050

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-098
ID

Other

Enumeration date
11/21/2012
Last updated
11/21/2012
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