Provider Demographics
NPI:1073972444
Name:COOPER, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14034-0389
Mailing Address - Country:US
Mailing Address - Phone:716-532-2231
Mailing Address - Fax:716-532-2200
Practice Address - Street 1:72 MIDDLE RD.
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14034-0389
Practice Address - Country:US
Practice Address - Phone:716-532-2231
Practice Address - Fax:716-532-2200
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator