MEDICARE: DANIELLA COOPER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1376139600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA COOPER

Provider Business Mailing Address
First Line	:	2340 21ST ST SW
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-1921
Country	:	US
Telephone Number	:	330-690-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 21ST ST SW
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-1921
Country	:	US
Telephone Number	:	330-690-0877
Fax Number	:

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

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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Directions to “ DANIELLA COOPER ” Practice Location

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