Provider Demographics
NPI:1386272649
Name:COOPER, QUINTEN BRICE
Entity type:Individual
Prefix:MR
First Name:QUINTEN
Middle Name:BRICE
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 MILL CREEK RD APT 2717
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-4236
Mailing Address - Country:US
Mailing Address - Phone:814-525-5605
Mailing Address - Fax:
Practice Address - Street 1:4387 W SWAMP RD # 521
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-1039
Practice Address - Country:US
Practice Address - Phone:484-393-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist