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NPI Code Detail

MEDICARE: LANNA KOOP OTR

MEDICARE: LANNA KOOP OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist
2225X00000XOccupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023400033
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANNA KOOP OTR
Provider Business Mailing Address
First Line : 4419 PEBBLE BROOK DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-5663
Country : US
Telephone Number : 419-515-8334
Fax Number :
Provider Business Practice Location Address
First Line : 2730 ISABELLA BLVD STE 10
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-8002
Country : US
Telephone Number : 904-372-4070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2015
Last Update Date : 02/19/2021

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Directions to “ LANNA KOOP OTR” Practice Location

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