Provider Demographics
NPI:1629259841
Name:KOPPLE, DAYNA (MT)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:KOPPLE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-0248
Mailing Address - Country:US
Mailing Address - Phone:406-220-0831
Mailing Address - Fax:
Practice Address - Street 1:1919 FAIRWAY DR
Practice Address - Street 2:ROOM 104
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5844
Practice Address - Country:US
Practice Address - Phone:406-220-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist