Individual
TEALYNN COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 CHANNING WAY, IDAHO FALLS, ID 83404-7534
(208) 529-0067
Mailing address
1820 HEATHER CIR, AMMON, ID 83406-6791
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1465
ID
Other
Enumeration date
06/27/2017
Last updated
06/27/2017
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