Provider Demographics
NPI:1619481322
Name:KOPP, EMMA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:KOPP
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1762 N DAISY DR
Mailing Address - Street 2:
Mailing Address - City:GENOA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53128-1170
Mailing Address - Country:US
Mailing Address - Phone:262-295-8375
Mailing Address - Fax:262-295-8375
Practice Address - Street 1:1532 W CLYBOURN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2202
Practice Address - Country:US
Practice Address - Phone:414-288-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer