Provider Demographics
NPI:1033752894
Name:COOPER, BETHANY LANAE'
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LANAE'
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:LANAE'
Other - Last Name:CARRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2037 SIDNEYWOOD DR APT B
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 N EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-8470
Practice Address - Country:US
Practice Address - Phone:937-775-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program