Provider Demographics
NPI:1659157907
Name:COOPER, SHAUNA RACHEL (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:RACHEL
Last Name:COOPER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 EATON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-8683
Mailing Address - Country:US
Mailing Address - Phone:214-931-4119
Mailing Address - Fax:
Practice Address - Street 1:706 RED COAT DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2200
Practice Address - Country:US
Practice Address - Phone:254-742-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210870224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant