Provider Demographics
NPI:1255827382
Name:MITCHELL-COPLEN, KARI (PTA)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:MITCHELL-COPLEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:
Other - Last Name:COPLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2413 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-7709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107
Practice Address - Country:US
Practice Address - Phone:269-409-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003733225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant