Provider Demographics
NPI:1164634788
Name:COOPER, JOANNE BARRY (LMP)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:BARRY
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 CAIN RD
Mailing Address - Street 2:# 20
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3073
Mailing Address - Country:US
Mailing Address - Phone:360-493-8677
Mailing Address - Fax:
Practice Address - Street 1:302 COLUMBIA ST FUSION
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-3073
Practice Address - Country:US
Practice Address - Phone:360-596-9696
Practice Address - Fax:360-596-9797
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017850225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist