Provider Demographics
NPI:1922305846
Name:COUPERUS, BOBBIE JO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JO
Last Name:COUPERUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 KANIA RD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6607
Mailing Address - Country:US
Mailing Address - Phone:518-212-5306
Mailing Address - Fax:
Practice Address - Street 1:100 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-2193
Practice Address - Country:US
Practice Address - Phone:518-954-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-13
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008957-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics