Healthcare Provider Details

I. General information

NPI: 1346299385
Provider Name (Legal Business Name): LEAH E COOPER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 UNDERHILL RD
BEEBE AR
72012-9751
US

IV. Provider business mailing address

140 SUNNYSIDE DR
BATESVILLE AR
72501-9628
US

V. Phone/Fax

Practice location:
  • Phone: 501-230-3100
  • Fax: 501-882-9825
Mailing address:
  • Phone: 870-307-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1996
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: