Provider Demographics
NPI:1659510501
Name:COOPER-DESMOND, ERIKA (LMT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:COOPER-DESMOND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 WILLAGILLESPIE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2142
Mailing Address - Country:US
Mailing Address - Phone:541-343-4913
Mailing Address - Fax:
Practice Address - Street 1:1142 WILLAGILLESPIE RD STE 10
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2142
Practice Address - Country:US
Practice Address - Phone:541-343-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist