Healthcare Provider Details

I. General information

NPI: 1255814042
Provider Name (Legal Business Name): MUSU BOIMA COKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9477 MUIRKIRK RD APT 101
LAUREL MD
20708-2799
US

IV. Provider business mailing address

9477 MUIRKIRK RD APT 101
LAUREL MD
20708-2799
US

V. Phone/Fax

Practice location:
  • Phone: 708-580-1106
  • Fax:
Mailing address:
  • Phone: 708-580-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number08543
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number08543
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number08543
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: