Provider Demographics
NPI:1912545377
Name:COPPES, DANIELLE LEIGH (MED,AT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEIGH
Last Name:COPPES
Suffix:
Gender:F
Credentials:MED,AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-4302
Mailing Address - Country:US
Mailing Address - Phone:419-372-7089
Mailing Address - Fax:419-372-0123
Practice Address - Street 1:1610 STADIUM DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-4302
Practice Address - Country:US
Practice Address - Phone:419-372-7089
Practice Address - Fax:419-372-0123
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0043922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer