Provider Demographics
NPI:1679938872
Name:COOPER, SANDRA RENEE (RPSGT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RENEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 GLASS MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-8355
Mailing Address - Country:US
Mailing Address - Phone:352-321-1732
Mailing Address - Fax:
Practice Address - Street 1:761 TANK BATTALION
Practice Address - Street 2:BLDG. 412
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-4906
Practice Address - Country:US
Practice Address - Phone:254-553-7720
Practice Address - Fax:254-553-7724
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13706246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other