Provider Demographics
NPI:1184496317
Name:COOPER, TIFFANY PURCELL (COTA/L)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:PURCELL
Last Name:COOPER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 DOWNY DR APT 51
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-7141
Mailing Address - Country:US
Mailing Address - Phone:859-308-7135
Mailing Address - Fax:
Practice Address - Street 1:9255 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-7199
Practice Address - Country:US
Practice Address - Phone:859-384-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY137625224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant