Individual
JENNIFER COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
228 STUTELY LN, SPRINGFIELD, IL 62704-5234
(217) 473-0843
Mailing address
228 STUTELY LN, SPRINGFIELD, IL 62704-5234
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003332
IL
Other
Enumeration date
04/01/2020
Last updated
04/01/2020
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