Individual
MR. THEODORE DALTON COOKINHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
503 W OCEAN BLVD, LOS FRESNOS, TX 78566-3635
(956) 233-4111
Mailing address
503 W OCEAN BLVD, LOS FRESNOS, TX 78566-3635
(956) 233-4111
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210099
TX
Other
Enumeration date
08/01/2018
Last updated
08/01/2018
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