Healthcare Provider Details

I. General information

NPI: 1811121239
Provider Name (Legal Business Name): LORI S COOPER-OTT M.ED, CAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 ROOSEVELT AVE
YORK PA
17404-2350
US

IV. Provider business mailing address

1195 ROOSEVELT AVE
YORK PA
17404-2350
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-0800
  • Fax: 717-843-3222
Mailing address:
  • Phone: 717-843-0800
  • Fax: 717-843-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC#3506
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: