Provider Demographics
NPI:1366657975
Name:COPLEY, NATALIE S (LMP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:S
Last Name:COPLEY
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:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98345-0821
Mailing Address - Country:US
Mailing Address - Phone:360-471-1845
Mailing Address - Fax:360-698-0316
Practice Address - Street 1:160 BETHEL AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5218
Practice Address - Country:US
Practice Address - Phone:360-471-1845
Practice Address - Fax:360-698-0316
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist