Provider Demographics
NPI:1013175819
Name:COOPER, ANN CHARISE LUCIANO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANN CHARISE
Middle Name:LUCIANO
Last Name:COOPER
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 1:18176 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-6821
Mailing Address - Country:US
Mailing Address - Phone:541-264-0285
Mailing Address - Fax:
Practice Address - Street 1:405 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7345
Practice Address - Country:US
Practice Address - Phone:503-666-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1073508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist