Individual
JEREMIAH W COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
310 S 3RD ST, CARLTON, OR 97111-0610
(503) 939-2946
Mailing address
PO BOX 610, CARLTON, OR 97111-0610
(503) 939-2946
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13614
OR
225700000X
Massage Therapist
MA00023290
WA
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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