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General NPI Number Information
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NPI Number | 1609710615
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Entity Type | Individual
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Provider Name | JAYME COOPER
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Gender | Female
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Dates
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Enumeration Date | 04/18/2026
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Last Update Date | 04/18/2026
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Provider Practice Location Address
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Address Line | 11913 BRAGG AVE
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City | LOUISVILLE
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State | KY
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Zip | 40243-1319
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Country | US
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Telephone | 502-414-4851
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Fax |
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Provider Business Mailing Address
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Address Line | 11913 BRAGG AVE
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City | LOUISVILLE
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State | KY
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Zip | 40243-1319
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Country | US
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Telephone | 502-414-4851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 134982
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License Number State | KY
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