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General NPI Number Information
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NPI Number | 1629479449
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Entity Type | Organization
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Legal Business Name | KELLIE RAE COOMBS
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 43 WILLOW RD
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City | TEQUESTA
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State | FL
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Zip | 33469-2615
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Country | US
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Telephone | 561-628-3135
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WILLOW RD
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City | TEQUESTA
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State | FL
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Zip | 33469-2615
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Country | US
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Telephone | 561-628-3135
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REHABILITATION
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Name | MRS. KELLIE RAE COOMBS
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Credential | OTR/L
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Telephone | 561-628-3135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OT10741
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License Number State | FL
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