Provider Demographics
NPI:1558175505
Name:COOPER, TESSA W (MS NUTRITION)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:W
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 OLD CONNECTICUT PATH
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3124
Mailing Address - Country:US
Mailing Address - Phone:617-803-7979
Mailing Address - Fax:
Practice Address - Street 1:196 OLD CONNECTICUT PATH
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3124
Practice Address - Country:US
Practice Address - Phone:617-803-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist