Provider Demographics
NPI:1841488475
Name:COOLEY, JENNIFER A (OTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:COOLEY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23013 WESTCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8448
Mailing Address - Country:US
Mailing Address - Phone:941-625-1100
Mailing Address - Fax:941-235-2327
Practice Address - Street 1:23013 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8448
Practice Address - Country:US
Practice Address - Phone:941-625-1100
Practice Address - Fax:941-235-2327
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9885224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant