Provider Demographics
NPI:1730573775
Name:COOPERSMITH, ANNA RENEE (OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:RENEE
Last Name:COOPERSMITH
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:RENEE
Other - Last Name:DELUE COOPERSMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:320 TESCONI CIR
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4611
Mailing Address - Country:US
Mailing Address - Phone:707-544-2637
Mailing Address - Fax:707-544-2088
Practice Address - Street 1:320 TESCONI CIR
Practice Address - Street 2:G
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4611
Practice Address - Country:US
Practice Address - Phone:707-544-2637
Practice Address - Fax:707-544-2088
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6007174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist