Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 684 | ND |
N | 2251H1300X | Human Factors | 684 | ND |
N | 225XH1300X | Human Factors | 684 | ND |
N | 225XP0200X | Occupational Therapist - Pediatrics | 684 | ND |
NPI | 1063603934 |
---|---|
Provider Name | Tara Marie Coble |
First Address | East Grand Forks, MN 56721-1238 |
Second Address | Larimore, ND 58251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 06/08/2007 |