Healthcare Provider Details

I. General information

NPI: 1619399508
Provider Name (Legal Business Name): ANN COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 EIGHMY RD
MCFARLAND WI
53558-9686
US

IV. Provider business mailing address

5410 EIGHMY RD
MCFARLAND WI
53558-9686
US

V. Phone/Fax

Practice location:
  • Phone: 608-620-3126
  • Fax:
Mailing address:
  • Phone: 608-620-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR-1050
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7334-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: