MEDICARE: JESSICA COPLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT/015361	OH

General Provider Information

NPI Number	:	1255711560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA COPLEY

Provider Business Mailing Address
First Line	:	4851 WUNNENBERG WAY
Second Line	:	SUITE D
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4855
Country	:	US
Telephone Number	:	513-874-8800
Fax Number	:	513-672-0519

Provider Business Practice Location Address
First Line	:	4851 WUNNENBERG WAY
Second Line	:	SUITE D
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4855
Country	:	US
Telephone Number	:	513-874-8800
Fax Number	:	513-672-0519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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Directions to “ JESSICA COPLEY ” Practice Location

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