Provider Demographics
NPI:1871152744
Name:COOKE, HEIDI (OTR)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:COOKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 WINTER GARDEN VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4380
Mailing Address - Country:US
Mailing Address - Phone:407-654-5455
Mailing Address - Fax:407-654-5829
Practice Address - Street 1:1201 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4380
Practice Address - Country:US
Practice Address - Phone:407-654-5455
Practice Address - Fax:407-654-5829
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20078225X00000X
AL5027225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist