Provider Demographics
NPI:1740526540
Name:COOPER, FELICIA ADRIENNE (ATC)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:ADRIENNE
Last Name:COOPER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7822 SNOWFLAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8077
Mailing Address - Country:US
Mailing Address - Phone:216-990-6545
Mailing Address - Fax:
Practice Address - Street 1:7822 SNOWFLAKE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8077
Practice Address - Country:US
Practice Address - Phone:216-990-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-25
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002047A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer