Provider Demographics
NPI:1639490923
Name:COOPER, DANIALLE LEE (LMP)
Entity Type:Individual
Prefix:
First Name:DANIALLE
Middle Name:LEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:DANIALLE
Other - Middle Name:LEE
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:721 S LINCOLN ST
Mailing Address - Street 2:A2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2904
Mailing Address - Country:US
Mailing Address - Phone:509-302-9988
Mailing Address - Fax:
Practice Address - Street 1:721 S LINCOLN ST
Practice Address - Street 2:A2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2904
Practice Address - Country:US
Practice Address - Phone:509-302-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60143917225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist