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General NPI Number Information
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NPI Number | 1730492125
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Entity Type | Individual
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Provider Name | CAROLINE D COPELAND OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 129 E LAKE ST
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1104
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Country | US
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Telephone | 630-295-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 7639 WILCOX ST
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City | FOREST PARK
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State | IL
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Zip | 60130-1818
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Country | US
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Telephone | 708-771-4819
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056002224
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License Number State | IL
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