Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0305 | AL |
NPI | 1053753830 |
---|---|
Provider Name | Sandra Owen Coker |
First Address | Mc Calla, AL 35111-3962 |
Second Address | Pelham, AL 35124-4302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 22/07/2013 |