Provider Demographics
NPI:1073579744
Name:COOPER, RAYMOND WESLEY JR (OT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:WESLEY
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:807A S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3610
Mailing Address - Country:US
Mailing Address - Phone:410-939-2262
Mailing Address - Fax:410-939-7119
Practice Address - Street 1:1131 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5132
Practice Address - Country:US
Practice Address - Phone:410-838-6070
Practice Address - Fax:410-838-6961
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02327225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD954LN386Medicare ID - Type Unspecified
MDQ64012Medicare UPIN