Provider Demographics
NPI:1740517085
Name:COOPER, MARY YANTIS (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:YANTIS
Last Name:COOPER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7807 BAYMEADOWS RD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9664
Mailing Address - Country:US
Mailing Address - Phone:904-398-4133
Mailing Address - Fax:904-398-4148
Practice Address - Street 1:7807 BAYMEADOWS RD E
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9664
Practice Address - Country:US
Practice Address - Phone:904-398-4133
Practice Address - Fax:904-398-4148
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13813225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology