Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT13673 | CA |
N | 225XH1200X | Occupational Therapist - Hand | 3099 | AZ |
NPI | 1124191424 |
---|---|
Provider Name | Holly Coulson |
First Address | Vail, CO 81658-7520 |
Second Address | Vail, CO 81657-5242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 21/12/2021 |