Healthcare Provider Details

I. General information

NPI: 1396466280
Provider Name (Legal Business Name): MS. SUSAN LYNN COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E MULBERRY ST
LANCASTER OH
43130-3166
US

IV. Provider business mailing address

345 E MULBERRY ST
LANCASTER OH
43130-3166
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-7300
  • Fax:
Mailing address:
  • Phone: 740-687-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006562
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: