Individual
MALLORY CATHERINE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
2140 MERCED ST, FRESNO, CA 93721-1721
(559) 892-1125
Mailing address
2140 MERCED ST, FRESNO, CA 93721-1721
(559) 892-1125
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
69061
CA
Other
Enumeration date
08/15/2017
Last updated
08/15/2017
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