Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00508300 | NJ |
NPI | 1619443199 |
---|---|
Provider Name | Colleen Cooper |
First Address | Long Valley, NJ 07853-3242 |
Second Address | Flemington, NJ 08822-5793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2018 |
Last Update Date | 22/10/2018 |