Provider Demographics
NPI:1174744932
Name:COOPER, BRADLEY ALAN (OT)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ALAN
Last Name:COOPER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CARMELITA CV
Mailing Address - Street 2:
Mailing Address - City:SHAW
Mailing Address - State:MS
Mailing Address - Zip Code:38773-9619
Mailing Address - Country:US
Mailing Address - Phone:662-846-7228
Mailing Address - Fax:662-843-5434
Practice Address - Street 1:12 CARMELITA CV
Practice Address - Street 2:
Practice Address - City:SHAW
Practice Address - State:MS
Practice Address - Zip Code:38773-9619
Practice Address - Country:US
Practice Address - Phone:662-846-7228
Practice Address - Fax:662-843-5434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0258225X00000X, 225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics