Provider Demographics
NPI:1356304208
Name:COOPERMAN, MERYL S (OT)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:S
Last Name:COOPERMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1428
Mailing Address - Country:US
Mailing Address - Phone:215-340-2216
Mailing Address - Fax:
Practice Address - Street 1:920 TOWN CTR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901-5182
Practice Address - Country:US
Practice Address - Phone:215-340-2216
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002291L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30013746OtherKEYSTONE MERCY HEALTH PLA
PA756510OtherBC/BS
PA01970626Medicaid
PA2424667OtherUNITED HEATLHCARE