Healthcare Provider Details

I. General information

NPI: 1699396887
Provider Name (Legal Business Name): EMILY JOY KOOPS MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 COMBES AVE
THOUSAND OAKS CA
91360-5418
US

IV. Provider business mailing address

574 COMBES AVE
THOUSAND OAKS CA
91360-5418
US

V. Phone/Fax

Practice location:
  • Phone: 816-678-7377
  • Fax:
Mailing address:
  • Phone: 816-678-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-04426
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2024040938
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number24811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: