Individual
JIM COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2404 E EMPIRE ST, BLOOMINGTON, IL 61704-3630
(309) 663-8275
(309) 662-7872
Mailing address
507 E ARMSTRONG AVE, PEORIA, IL 61603-3201
(309) 663-8275
(309) 662-7872
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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