Provider Demographics
NPI:1205184504
Name:COOPER, DOUGLAS JAY (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JAY
Last Name:COOPER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03255-5220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 BROWN RD
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:NH
Practice Address - Zip Code:03255-5220
Practice Address - Country:US
Practice Address - Phone:603-938-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant