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NPI Code Detail

MEDICARE: TERESA L COOPER MSOT

MEDICARE: TERESA L COOPER MSOT
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
1225XP0200XPediatric Occupational Therapist5201006016MI

General Provider Information

NPI Number : 1740551928
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA L COOPER MSOT
Provider Business Mailing Address
First Line : 2251 E PARIS AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2431
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2251 E PARIS AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2431
Country : US
Telephone Number : 616-447-7799
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2012
Last Update Date : 09/26/2018

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Directions to “ TERESA L COOPER MSOT” Practice Location

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