MEDICARE: BRITTANY 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	225700000X	Massage Therapist	19519	OR

General Provider Information

NPI Number	:	1760866289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY COOPER

Provider Business Mailing Address
First Line	:	280 S WALL ST
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-3219
Country	:	US
Telephone Number	:	541-252-1316
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1202
Country	:	US
Telephone Number	:	541-252-1316
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	02/27/2020

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Directions to “ BRITTANY COOPER ” Practice Location

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