Provider Demographics
NPI:1154691384
Name:KOPP, SALINA MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SALINA
Middle Name:MARIE
Last Name:KOPP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N CHASE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1810
Mailing Address - Country:US
Mailing Address - Phone:518-848-6583
Mailing Address - Fax:
Practice Address - Street 1:207 N CHASE ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-1810
Practice Address - Country:US
Practice Address - Phone:518-848-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005889-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker