Provider Demographics
NPI:1831896745
Name:KOOP, ALLISON LAUREN (OT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LAUREN
Last Name:KOOP
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LAUREN
Other - Last Name:HANDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:2960 OAKBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3545
Mailing Address - Country:US
Mailing Address - Phone:631-258-9626
Mailing Address - Fax:
Practice Address - Street 1:7005 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2181
Practice Address - Country:US
Practice Address - Phone:248-939-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201012952225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist