Provider Demographics
NPI:1881346047
Name:KOPP, CARALENA MARIE (RMP)
Entity type:Individual
Prefix:MRS
First Name:CARALENA
Middle Name:MARIE
Last Name:KOPP
Suffix:
Gender:F
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 WOOD GLENN CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-7005
Mailing Address - Country:US
Mailing Address - Phone:410-852-8527
Mailing Address - Fax:
Practice Address - Street 1:614 WOOD GLENN CT
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-7005
Practice Address - Country:US
Practice Address - Phone:410-852-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR03267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty