Individual
KELLI COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, PTA
Contact information
Practice address
2225 W SOUTHERN AVE, MESA, AZ 85202-4716
(480) 412-4101
Mailing address
1438 E ANGELINE AVE, SAN TAN VALLEY, AZ 85140-4063
(480) 703-6430
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
OTH-006878
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7773A
LICENSE#
AZ
01
—
OTH-006878
LICENSE#
AZ
Enumeration date
08/17/2007
Last updated
11/06/2018
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