Provider Demographics
NPI:1588135248
Name:KOERPER, JENNIFER A (COTA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:KOERPER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 S HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:MO
Mailing Address - Zip Code:64485-1952
Mailing Address - Country:US
Mailing Address - Phone:816-324-3185
Mailing Address - Fax:816-324-2040
Practice Address - Street 1:1116 4TH ST
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-9312
Practice Address - Country:US
Practice Address - Phone:816-872-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003001988225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2003001988OtherMO OT LICENSURE
MOR998587733OtherMO DRIVERS LICENSE