Provider Demographics
NPI:1578768511
Name:COPELAND, JOAN (OTA)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:COPELAND
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 1:7295 HIGHWAY HH
Mailing Address - Street 2:
Mailing Address - City:CATAWISSA
Mailing Address - State:MO
Mailing Address - Zip Code:63015-1296
Mailing Address - Country:US
Mailing Address - Phone:636-257-6503
Mailing Address - Fax:
Practice Address - Street 1:105 S 6TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1328
Practice Address - Country:US
Practice Address - Phone:636-271-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000146274224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant