MEDICARE: MRS. AMY DELL COOPERMAN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	03680	MD

General Provider Information

NPI Number	:	1114181849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY DELL COOPERMAN OTR/L

Provider Business Mailing Address
First Line	:	2712 SMITH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2504
Country	:	US
Telephone Number	:	410-653-8051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 SMITH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2504
Country	:	US
Telephone Number	:	410-653-8051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	07/11/2008

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