Provider Demographics
NPI:1851906135
Name:COPLEY, BRENDAN (MBA, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:
Last Name:COPLEY
Suffix:
Gender:M
Credentials:MBA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 BELAIR DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6544
Mailing Address - Country:US
Mailing Address - Phone:802-233-3634
Mailing Address - Fax:
Practice Address - Street 1:352 BELAIR DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6544
Practice Address - Country:US
Practice Address - Phone:802-233-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000028301OtherBOC