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General NPI Number Information
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NPI Number | 1134669617
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Entity Type | Individual
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Provider Name | DOUGLAS COPELAND
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Gender | Male
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1110 K ST
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City | EUREKA
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State | CA
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Zip | 95501-2458
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Country | US
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Telephone | 949-285-3209
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 K ST
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City | EUREKA
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State | CA
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Zip | 95501-2458
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Country | US
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Telephone | 949-285-3209
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA2795
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License Number State | CA
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