Provider Demographics
NPI:1659632289
Name:KOPEPASSAH, MARGARET LESLIE (BS)
Entity type:Individual
Prefix:MISS
First Name:MARGARET
Middle Name:LESLIE
Last Name:KOPEPASSAH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 SW PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8030
Mailing Address - Country:US
Mailing Address - Phone:580-585-0482
Mailing Address - Fax:
Practice Address - Street 1:2 SE LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-2409
Practice Address - Country:US
Practice Address - Phone:580-585-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor