Provider Demographics
NPI:1265890644
Name:KOPER, ANGELA (CST, BHA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KOPER
Suffix:
Gender:F
Credentials:CST, BHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 RABIDUE RD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:MI
Mailing Address - Zip Code:48049-2926
Mailing Address - Country:US
Mailing Address - Phone:810-334-4481
Mailing Address - Fax:
Practice Address - Street 1:4429 RABIDUE RD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:MI
Practice Address - Zip Code:48049-2926
Practice Address - Country:US
Practice Address - Phone:810-334-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 251B00000X, 251K00000X, 253Z00000X
93807246ZS0410X, 246ZX2200X
MIE7830A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No174H00000XOther Service ProvidersHealth Educator
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health