Provider Demographics
NPI:1730397431
Name:KOPEY, STEPHANIE A (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:KOPEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:PHILLIPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-306-6936
Mailing Address - Fax:330-306-3697
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-306-6936
Practice Address - Fax:330-306-3697
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009537208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2966643Medicaid
OHH149730OtherMEDICARE PTAN