Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | 006511 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 006511 | NY |
NPI | 1336393149 |
---|---|
Provider Name | Dale A Coffin |
First Address | North Baldwin, NY 11510-1421 |
Second Address | North Baldwin, NY 11510-1421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2008 |
Last Update Date | 06/11/2008 |