Provider Demographics
NPI:1033821780
Name:KOPAL, EMILY ROSE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:KOPAL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 S COLORADO ROAD 5
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8010 S COLORADO ROAD 5
Practice Address - Street 2:SUITE 103
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528
Practice Address - Country:US
Practice Address - Phone:970-581-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT000732225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist