Provider Demographics
NPI:1912329459
Name:COOPERATIVE THERAPIES NW
Entity Type:Organization
Organization Name:COOPERATIVE THERAPIES NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ASSISTANT AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-433-8085
Mailing Address - Street 1:7759 SW CIRRUS DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5968
Mailing Address - Country:US
Mailing Address - Phone:503-433-8085
Mailing Address - Fax:
Practice Address - Street 1:7759 SW CIRRUS DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5968
Practice Address - Country:US
Practice Address - Phone:503-433-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR233731225X00000X
OR13513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty