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General NPI Number Information
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NPI Number | 1760866289
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Entity Type | Individual
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Provider Name | BRITTANY COOPER
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 3436 BROADWAY AVE
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City | NORTH BEND
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State | OR
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Zip | 97459-1202
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Country | US
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Telephone | 541-252-1316
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Fax |
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Provider Business Mailing Address
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Address Line | 280 S WALL ST
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City | COOS BAY
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State | OR
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Zip | 97420-3219
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Country | US
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Telephone | 541-252-1316
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 19519
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License Number State | OR
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