Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 00003728 | WA |
NPI | 1003151747 |
---|---|
Provider Name | Mrs. Jennifer Marie Coleman |
First Address | Everett, WA 98204-3784 |
Second Address | Everett, WA 98204-3784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 06/12/2012 |