Provider Demographics
NPI:1114124781
Name:COOPER, CATHERINE T (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:T
Last Name:COOPER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8632
Mailing Address - Country:US
Mailing Address - Phone:859-623-8708
Mailing Address - Fax:
Practice Address - Street 1:411 BERTHA WALLACE DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-9418
Practice Address - Country:US
Practice Address - Phone:606-723-5153
Practice Address - Fax:606-723-7765
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY185339Medicaid