MEDICARE: MR. QUINTEN BRICE COOPER

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
1	225X00000X	Occupational Therapist	OC015243	PA

General Provider Information

NPI Number	:	1386272649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. QUINTEN BRICE COOPER

Provider Business Mailing Address
First Line	:	9071 MILL CREEK RD APT 2717
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19054-4236
Country	:	US
Telephone Number	:	814-525-5605
Fax Number	:

Provider Business Practice Location Address
First Line	:	4387 W SWAMP RD # 521
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18902-1039
Country	:	US
Telephone Number	:	484-393-2243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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Directions to “ MR. QUINTEN BRICE COOPER ” Practice Location

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