MEDICARE: CECELIA COOPER P.A.

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1326411943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CECELIA COOPER P.A.

Provider Business Mailing Address
First Line	:	2821 E COMMERCIAL BLVD
Second Line	:	#202
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 E COMMERCIAL BLVD
Second Line	:	#202
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:	954-804-0298
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	CECELIA ANNE COOPER
Credential	:	M.ED. CCC-SLP
Telephone Number	:	954-804-0298

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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