Provider Demographics
NPI:1285828848
Name:COOPER, KATHLEEN J
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:J
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 1:2332 HARPER CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5257
Mailing Address - Country:US
Mailing Address - Phone:321-264-2362
Mailing Address - Fax:321-264-2362
Practice Address - Street 1:2332 HARPER CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5257
Practice Address - Country:US
Practice Address - Phone:321-264-2362
Practice Address - Fax:321-264-2362
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant