Provider Demographics
NPI:1659698710
Name:KOPSHY, ANGELA KRISTIN (MM, MT-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KRISTIN
Last Name:KOPSHY
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14726 ALBERS WAY NE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-9532
Mailing Address - Country:US
Mailing Address - Phone:971-221-7144
Mailing Address - Fax:
Practice Address - Street 1:14726 ALBERS WAY NE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OR
Practice Address - Zip Code:97002-9532
Practice Address - Country:US
Practice Address - Phone:971-221-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist