Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 906 | WV |
N | 225XH1200X | Occupational Therapist - Hand | 1041100065 | WV |
NPI | 1275612004 |
---|---|
Provider Name | Jill E. Coulter |
First Address | Hurricane, WV 25526-9756 |
Second Address | Hurricane, WV 25526-9756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9440132000 | (05) | WV |