Provider Demographics
NPI:1568004950
Name:COOPER, HANA G (MOT)
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:G
Last Name:COOPER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AIR PARK RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-7022
Mailing Address - Country:US
Mailing Address - Phone:662-842-2100
Mailing Address - Fax:662-842-2105
Practice Address - Street 1:600 AIR PARK RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-7022
Practice Address - Country:US
Practice Address - Phone:662-842-2100
Practice Address - Fax:662-842-2105
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist