Individual
GRACE JANINE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 MUNSON AVE, TRAVERSE CITY, MI 49686-3059
(231) 486-6330
Mailing address
415 MUNSON AVE, TRAVERSE CITY, MI 49686-3059
(231) 486-6330
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201011388
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FDC921054121
BLUE CROSS BLUE SHIELD-IL
IL
Enumeration date
11/15/2021
Last updated
11/15/2021
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