Provider Demographics
NPI:1013200799
Name:COPLEY, LAURA RAE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RAE
Last Name:COPLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8937 N WESTANNA AVE
Mailing Address - Street 2:#26
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2668
Mailing Address - Country:US
Mailing Address - Phone:503-459-3448
Mailing Address - Fax:503-735-0471
Practice Address - Street 1:8937 N WESTANNA AVE
Practice Address - Street 2:#26
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-2668
Practice Address - Country:US
Practice Address - Phone:503-459-3448
Practice Address - Fax:503-735-0471
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60202682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist