Provider Demographics
NPI:1891398814
Name:SINGLETON COOPER, TERESE (MSOT)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:
Last Name:SINGLETON COOPER
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 LAKESHORE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5695
Mailing Address - Country:US
Mailing Address - Phone:337-257-9060
Mailing Address - Fax:
Practice Address - Street 1:505 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1645
Practice Address - Country:US
Practice Address - Phone:985-643-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist