Provider Demographics
NPI:1609617596
Name:COOK, MELODY MARIE
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 AVIATORS PT
Mailing Address - Street 2:
Mailing Address - City:ELEANOR
Mailing Address - State:WV
Mailing Address - Zip Code:25070-1382
Mailing Address - Country:US
Mailing Address - Phone:304-610-5402
Mailing Address - Fax:
Practice Address - Street 1:460 AVIATORS PT
Practice Address - Street 2:
Practice Address - City:ELEANOR
Practice Address - State:WV
Practice Address - Zip Code:25070-1382
Practice Address - Country:US
Practice Address - Phone:304-610-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant