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General NPI Number Information
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NPI Number | 1225553571
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Entity Type | Organization
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Legal Business Name | COLEMAN PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 155 BORETZ RD
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City | COLCHESTER
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State | CT
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Zip | 06415
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Country | US
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Telephone | 860-383-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 155 BORETZ RD
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City | COLCHESTER
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State | CT
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Zip | 06415
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Country | US
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Telephone | 860-383-3320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATIE J COLEMAN
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Credential | OTR/L
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Telephone | 860-383-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 003634
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License Number State | CT
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