Healthcare Provider Details

I. General information

NPI: 1750680161
Provider Name (Legal Business Name): KATHERINE ELIZABETH COOPER OTR/L, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402
APO AE
09180
US

IV. Provider business mailing address

CMR 467 BOX 4846
APO AE
09096-0049
US

V. Phone/Fax

Practice location:
  • Phone: 01625616226
  • Fax:
Mailing address:
  • Phone: 609-240-6657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number06247
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: