Provider Demographics
NPI:1063538031
Name:KOPKE, WILLIAM ALAN (MED, OTR/L, CLT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALAN
Last Name:KOPKE
Suffix:
Gender:M
Credentials:MED, OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 EL RANCHO LANE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1329
Mailing Address - Country:US
Mailing Address - Phone:815-977-5950
Mailing Address - Fax:
Practice Address - Street 1:2006 EL RANCHO LANE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1329
Practice Address - Country:US
Practice Address - Phone:815-977-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 14154225XP0200X
GA1539225XP0200X
NC3331225XP0200X
NBCOT992514225XP0200X
IL056.011337225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1385XOtherBCBS OF NORTH CAROLINA
NC7301397Medicaid