Basic Information
| Provider Information | |||||||||
| NPI: | 1801263371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COONS | ||||||||
| FirstName: | JODI | ||||||||
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| OtherLastName: | PETERSOLI | ||||||||
| OtherFirstName: | JODI | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 84 OLD PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | LEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012389446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132434241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 CHRISTIAN HILL RD | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135284560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2015 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 2887 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 953 | CT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.