Healthcare Provider Details

I. General information

NPI: 1740897255
Provider Name (Legal Business Name): JORDAN KUPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 COUNTRY CLUB PLAZA DR UNIT 1570
SAINT CHARLES MO
63303-3859
US

IV. Provider business mailing address

3489 BOSCHERTOWN RD
SAINT CHARLES MO
63301-3213
US

V. Phone/Fax

Practice location:
  • Phone: 636-724-1127
  • Fax:
Mailing address:
  • Phone: 636-925-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2020007866
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: