MEDICARE: MR. BRENT COOPER ORR ATP

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	247200000X	Other Technician		TX

General Provider Information

NPI Number	:	1447548391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENT COOPER ORR ATP

Provider Business Mailing Address
First Line	:	7415 WHITEHALL STREET SUITE 118
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76118
Country	:	US
Telephone Number	:	817-589-0759
Fax Number	:	817-284-1798

Provider Business Practice Location Address
First Line	:	7415 WHITEHALL STREET SUITE 118
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76118
Country	:	US
Telephone Number	:	817-589-0759
Fax Number	:	817-284-1798

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

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2011

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Directions to “ MR. BRENT COOPER ORR ATP” Practice Location

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