Provider Demographics
NPI:1215282470
Name:COOPER, KAILYN
Entity type:Individual
Prefix:
First Name:KAILYN
Middle Name:
Last Name: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 1:700 S PENN AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3847
Mailing Address - Country:US
Mailing Address - Phone:918-337-8080
Mailing Address - Fax:918-337-8099
Practice Address - Street 1:700 S PENN AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3847
Practice Address - Country:US
Practice Address - Phone:918-337-8080
Practice Address - Fax:918-337-8099
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner