Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 102128 | MN |
NPI | 1104932789 |
---|---|
Provider Name | Ray V Coyle |
First Address | Woodbury, MN 55125-4925 |
Second Address | Saint Paul, MN 55102-2463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 01/07/2015 |