Provider Demographics
NPI:1801263371
Name:COONS, JODI
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:COONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:PETERSOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:84 OLD PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-9446
Mailing Address - Country:US
Mailing Address - Phone:413-243-4241
Mailing Address - Fax:
Practice Address - Street 1:151 CHRISTIAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1108
Practice Address - Country:US
Practice Address - Phone:413-528-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2887224Z00000X
CT953224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant