Provider Demographics
NPI:1013382407
Name:COOPER, MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 S SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3712
Mailing Address - Country:US
Mailing Address - Phone:858-353-4784
Mailing Address - Fax:
Practice Address - Street 1:66 GEORGE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29424-0001
Practice Address - Country:US
Practice Address - Phone:843-953-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer