Provider Demographics
NPI:1720789878
Name:COOPER, LARRY BARTON
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:BARTON
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:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:WAR
Mailing Address - State:WV
Mailing Address - Zip Code:24892-0204
Mailing Address - Country:US
Mailing Address - Phone:304-800-9144
Mailing Address - Fax:
Practice Address - Street 1:145 EMMANUAL ST
Practice Address - Street 2:
Practice Address - City:WAR
Practice Address - State:WV
Practice Address - Zip Code:24892
Practice Address - Country:US
Practice Address - Phone:304-800-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant