Provider Demographics
NPI:1639432529
Name:COOPER, LAURA (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:187 TANK FARM RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7081
Mailing Address - Country:US
Mailing Address - Phone:805-545-8699
Mailing Address - Fax:805-545-8699
Practice Address - Street 1:187 TANK FARM RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7081
Practice Address - Country:US
Practice Address - Phone:805-545-8699
Practice Address - Fax:805-545-8699
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist