MEDICARE: EMRIE CLAIRE COOPER MSOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	295638	KY

General Provider Information

NPI Number	:	1164248589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMRIE CLAIRE COOPER MSOT

Provider Business Mailing Address
First Line	:	1301 BROADWAY ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-2503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 BROADWAY ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-2503
Country	:	US
Telephone Number	:	270-442-9205
Fax Number	:	270-442-1954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

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Directions to “ EMRIE CLAIRE COOPER MSOT” Practice Location

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