Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 6936 | OR |
NPI | 1164627261 |
---|---|
Provider Name | Jeryl M Cossette |
First Address | Oakridge, OR 97463-9541 |
Second Address | Oakridge, OR 97463-9541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/07/2007 |