Provider Demographics
NPI:1124277124
Name:COOPMAN, CHERYL (OTR)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:COOPMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:SOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 REGENCY CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6168
Mailing Address - Country:US
Mailing Address - Phone:262-798-9650
Mailing Address - Fax:262-798-9652
Practice Address - Street 1:275 REGENCY CT
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6168
Practice Address - Country:US
Practice Address - Phone:262-798-9650
Practice Address - Fax:262-798-9652
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1911-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1911-026OtherOCCUPATIONAL THERAPIST STATE LICENSE