Provider Demographics
NPI:1801009659
Name:COOPER, ASHLE NICOLE (MAT, ATC)
Entity Type:Individual
Prefix:
First Name:ASHLE
Middle Name:NICOLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-8654
Mailing Address - Country:US
Mailing Address - Phone:803-279-8935
Mailing Address - Fax:
Practice Address - Street 1:937 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0008
Practice Address - Country:US
Practice Address - Phone:706-399-6044
Practice Address - Fax:706-721-3495
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer