Provider Demographics
NPI:1821364449
Name:COPE, ELLENMARIE
Entity type:Individual
Prefix:
First Name:ELLENMARIE
Middle Name:
Last Name:COPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 DEISIUS ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4418
Mailing Address - Country:US
Mailing Address - Phone:718-984-2233
Mailing Address - Fax:718-984-4761
Practice Address - Street 1:348 DEISIUS ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4418
Practice Address - Country:US
Practice Address - Phone:718-984-2233
Practice Address - Fax:718-984-4761
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63007918225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist