Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT0258 | MS |
N | 2251E1200X | Ergonomics | OT0258 | MS |
N | 225XE1200X | Ergonomics | OT0258 | MS |
NPI | 1174744932 |
---|---|
Provider Name | Mr. Bradley Alan Cooper |
First Address | Shaw, MS 38773-9619 |
Second Address | Shaw, MS 38773-9619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |