Provider Demographics
NPI:1609126085
Name:COOPER, STANLEY JR (DI)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 BRENTWOOD DR.
Mailing Address - Street 2:APT. 5
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-227-3194
Mailing Address - Fax:
Practice Address - Street 1:6400 BRENTWOOD DR
Practice Address - Street 2:APT. 5
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9619
Practice Address - Country:US
Practice Address - Phone:270-227-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist