Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 08543 | MD |
NPI | 1255814042 |
---|---|
Provider Name | Musu Boima Coker |
First Address | Laurel, MD 20708-2799 |
Second Address | Laurel, MD 20708-2799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2018 |
Last Update Date | 08/09/2018 |