Provider Demographics
NPI:1104429836
Name:COOPER, JEFFREY ISAIAH
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ISAIAH
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8769 BROOKS CREEK DR APT 1808
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2083
Mailing Address - Country:US
Mailing Address - Phone:513-546-0566
Mailing Address - Fax:
Practice Address - Street 1:8769 BROOKS CREEK DR APT 1808
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2083
Practice Address - Country:US
Practice Address - Phone:513-546-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant