Provider Demographics
NPI:1992472047
Name:COOPER, NICHOLAS SCOTT (CPO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:COOPER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 MEDICAL PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6703
Mailing Address - Country:US
Mailing Address - Phone:704-510-1300
Mailing Address - Fax:704-510-1311
Practice Address - Street 1:8310 MEDICAL PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6703
Practice Address - Country:US
Practice Address - Phone:704-510-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist