Individual
SUSAN GAYLE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1050 FOX ACRES RD, HAILEY, ID 83333-8456
(208) 720-3729
Mailing address
820 S MAIN ST UNIT 3166, HAILEY, ID 83333-6319
(208) 720-3729
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT-475
ID
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-475
STATE LICENSE
ID
Enumeration date
06/04/2019
Last updated
07/02/2024
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