Most Relevant Information
Provider Data
| NPI Number: | 1003595737 |
| Provider Name: | TERACENIA COOPER |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/11/2023 |
| Last Updated: | 07/11/2023 |
Provider Practice Location
296 S FERDON BLVD
CRESTVIEW
FL
325363702
Practice Location Phone/Fax
| Phone: | 8503331279 |
| Fax: |
Provider Mailing Location
40 STATE HIGHWAY 83
DEFUNIAK SPRINGS
FL
324337404
Provider Mailing Phone/Fax
| Phone: | 8505859198 |
| Fax: |