Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 6613 | AZ |
NPI | 1215389028 |
---|---|
Provider Name | Chyna Coleman |
First Address | Gilbert, AZ 85234-2425 |
Second Address | Gilbert, AZ 85234-2425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2016 |
Last Update Date | 05/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
359505 | NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY (01) |