Provider Demographics
NPI:1568563716
Name:COOPER, KIM (OT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:COOPER
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 1:4209 FM 1208
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-4639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 N MIDLAND DR
Practice Address - Street 2:STE 4A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5500
Practice Address - Country:US
Practice Address - Phone:432-697-6677
Practice Address - Fax:432-697-6678
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist