Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32001544A | IN |
NPI | 1003324583 |
---|---|
Provider Name | Lori Coleman |
First Address | New Haven, IN 46774-2220 |
Second Address | Fort Wayne, IN 46825-5832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2018 |
Last Update Date | 18/01/2018 |