Healthcare Provider Details

I. General information

NPI: 1326031972
Provider Name (Legal Business Name): HEATHER D COOPER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 21
FAYETTEVILLE WV
25840-0021
US

IV. Provider business mailing address

9 YELLOW WOOD WAY
BECKLEY WV
25801-7126
US

V. Phone/Fax

Practice location:
  • Phone: 304-923-8834
  • Fax:
Mailing address:
  • Phone: 304-255-2376
  • Fax: 304-255-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001132
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: