Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2003001988 | MO |
NPI | 1588135248 |
---|---|
Provider Name | Ms. Jennifer A Koerper |
First Address | Savannah, MO 64485-1952 |
Second Address | Platte City, MO 64079-9312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2003001988 | MO OT LICENSURE (01) | MO |
R998587733 | MO DRIVERS LICENSE (01) | MO |