Provider Demographics
NPI:1275261299
Name:COPPER, JACQUELINE EILEEN
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:EILEEN
Last Name:COPPER
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 1:1957 WESTERN AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7511
Mailing Address - Country:US
Mailing Address - Phone:740-253-5263
Mailing Address - Fax:
Practice Address - Street 1:1957 WESTERN AVE APT 401
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7511
Practice Address - Country:US
Practice Address - Phone:740-253-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide