Provider Demographics
NPI:1548609183
Name:COOPER, GARY THOMAS (OT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:THOMAS
Last Name:COOPER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 RIVERSIDE DR STE 207
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2004
Mailing Address - Country:US
Mailing Address - Phone:740-953-1184
Mailing Address - Fax:614-702-7226
Practice Address - Street 1:6099 RIVERSIDE DR STE 207
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2004
Practice Address - Country:US
Practice Address - Phone:740-953-1184
Practice Address - Fax:614-702-7226
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist