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General NPI Number Information
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NPI Number | 1114566304
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Entity Type | Individual
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Provider Name | CAREY COOPER
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Gender | Female
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Dates
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Enumeration Date | 01/05/2020
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Last Update Date | 01/05/2020
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Provider Practice Location Address
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Address Line | 111 E MONUMENT AVE UNIT 412
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City | KISSIMMEE
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State | FL
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Zip | 34741-5774
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Country | US
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Telephone | 407-693-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 8050 CORKFIELD AVE
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City | ORLANDO
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State | FL
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Zip | 32832-5082
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Country | US
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Telephone | 407-693-6166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State | FL
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