Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1165 | CA |
NPI | 1255720678 |
---|---|
Provider Name | Paul S Cooper |
First Address | Ridgecrest, CA 93555-5638 |
Second Address | Ridgecrest, CA 93555-5638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 22/01/2015 |