Provider Demographics
NPI:1861527582
Name:THOMAS COOPER, MARY ANN
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:THOMAS COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306
Mailing Address - Country:US
Mailing Address - Phone:330-773-3888
Mailing Address - Fax:
Practice Address - Street 1:47 W BARTGES ST
Practice Address - Street 2:MARGARET LOCKETT
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311
Practice Address - Country:US
Practice Address - Phone:330-535-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH774054988102Medicaid