Healthcare Provider Details

I. General information

NPI: 1083165518
Provider Name (Legal Business Name): MICHELE COPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 MILL RD SUITE 10
SHEBOYGAN WI
53083-2058
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 920-451-1100
  • Fax:
Mailing address:
  • Phone: 732-529-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1518-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: