Healthcare Provider Details

I. General information

NPI: 1942119433
Provider Name (Legal Business Name): SHANNON LYNN COPLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28296 CHIEFTAIN DR
LOGAN OH
43138-9557
US

IV. Provider business mailing address

16101 COX RD
LOGAN OH
43138-8342
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-1171
  • Fax:
Mailing address:
  • Phone: 740-380-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA006982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: