Provider Demographics
NPI:1932334984
Name:COOPER, MOLLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:A
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-6276
Mailing Address - Country:US
Mailing Address - Phone:304-672-0077
Mailing Address - Fax:
Practice Address - Street 1:231 DAVIS ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1703
Practice Address - Country:US
Practice Address - Phone:304-672-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1069225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics