Healthcare Provider Details

I. General information

NPI: 1174431134
Provider Name (Legal Business Name): STACEY MARIE COOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CLERMONT CENTER DR
BATAVIA OH
45103-1990
US

IV. Provider business mailing address

1024 TRACY CT
CINCINNATI OH
45245-2756
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-8300
  • Fax:
Mailing address:
  • Phone: 513-735-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA003702
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: