Provider Demographics
NPI:1770865834
Name:COOPER, MARY L (MIDWIFE)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 TOWNSHIP ROAD 593
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9511
Mailing Address - Country:US
Mailing Address - Phone:330-749-9255
Mailing Address - Fax:
Practice Address - Street 1:1257 TOWNSHIP ROAD 593
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9511
Practice Address - Country:US
Practice Address - Phone:330-466-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay