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NPI Code Detail

MEDICARE: HOLLY COOPER

MEDICARE: HOLLY 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1578795720
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY COOPER
Provider Business Mailing Address
First Line : 1118 OAK ST SE
Second Line :
City : SALEM
State : OR
Zip : 97301-4019
Country : US
Telephone Number : 503-585-4949
Fax Number :
Provider Business Practice Location Address
First Line : 1118 OAK ST SE
Second Line :
City : SALEM
State : OR
Zip : 97301-4019
Country : US
Telephone Number : 503-585-4949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2009
Last Update Date : 08/20/2009

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Directions to “ HOLLY COOPER ” Practice Location

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