Provider Demographics
NPI:1659787323
Name:COOPER, CAITLIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1553
Mailing Address - Country:US
Mailing Address - Phone:631-582-3707
Mailing Address - Fax:631-582-3795
Practice Address - Street 1:1832 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1553
Practice Address - Country:US
Practice Address - Phone:631-582-3707
Practice Address - Fax:631-582-3795
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002552-1231H00000X
NY14000042431237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist