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General NPI Number Information
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NPI Number | 1306107719
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Entity Type | Individual
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Provider Name | TINA MARIE COOPERRIDER L. AC.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 436 S MARKET ST
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City | LOUDONVILLE
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State | OH
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Zip | 44842-1446
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Country | US
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Telephone | 567-217-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 808 W MAIN ST
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City | LOUDONVILLE
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State | OH
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Zip | 44842-9551
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Country | US
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Telephone | 419-606-1455
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 65.000216
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License Number State | OH
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