=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902088388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA D COFFEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2007
-----------------------------------------------------
Last Update Date | 05/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2149 SW 59TH ST 201
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-681-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2149 SW 59TH ST 201
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-681-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 204 OT
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------