MEDICARE: MS. LAREE LEE COOPER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	372600000X	Adult Companion
4	374U00000X	Home Health Aide
5	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	182507252	OTHER	WA	IPN

General Provider Information

NPI Number	:	1730640129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAREE LEE COOPER

Provider Business Mailing Address
First Line	:	7743 SEWARD PARK AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-4248
Country	:	US
Telephone Number	:	206-497-0470
Fax Number	:	206-497-0469

Provider Business Practice Location Address
First Line	:	7743 SEWARD PARK AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-4248
Country	:	US
Telephone Number	:	206-497-0470
Fax Number	:	206-497-0468

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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