Provider Demographics
NPI:1255711560
Name:COPLEY, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 WUNNENBERG WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4855
Mailing Address - Country:US
Mailing Address - Phone:513-874-8800
Mailing Address - Fax:513-672-0519
Practice Address - Street 1:4851 WUNNENBERG WAY
Practice Address - Street 2:SUITE D
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4855
Practice Address - Country:US
Practice Address - Phone:513-874-8800
Practice Address - Fax:513-672-0519
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT/015361174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist