Provider Demographics
NPI:1730368523
Name:KOOPER, REBECCA (AUDIOLOGIST)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:KOOPER
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SHORE RD
Mailing Address - Street 2:APT 6C
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:516-635-5394
Mailing Address - Fax:516-432-6085
Practice Address - Street 1:700 SHORE RD
Practice Address - Street 2:APT 6C
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:516-635-5394
Practice Address - Fax:516-432-6085
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3291231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist