Individual
MRS. KELLI ANNE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
6125 N SUNSHINE ST STE A, COEUR D ALENE, ID 83815-8688
(208) 772-0802
Mailing address
116 E WYOMING AVE, HAYDEN, ID 83835-9618
(208) 640-3902
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 60067981
WA
225700000X
Massage Therapist
MT109720
TX
Other
Enumeration date
11/17/2011
Last updated
12/07/2011
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