Healthcare Provider Details

I. General information

NPI: 1730841669
Provider Name (Legal Business Name): ADRIANA NICOLE COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129A HILLSIDE AVE # 11596
WILLISTON PARK NY
11596-2305
US

IV. Provider business mailing address

1351 COMMODORE RD
UNIONDALE NY
11553-1313
US

V. Phone/Fax

Practice location:
  • Phone: 516-742-5243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: