Provider Demographics
NPI:1649304916
Name:KUPER, JEANINE M (COTA)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:M
Last Name:KUPER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BIRCHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4911
Mailing Address - Country:US
Mailing Address - Phone:603-472-3901
Mailing Address - Fax:
Practice Address - Street 1:29 CENTER ST
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2948
Practice Address - Country:US
Practice Address - Phone:603-497-4128
Practice Address - Fax:603-497-4085
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH536224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant