MEDICARE: KIRSTEN L COKER M.S., CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP853	ME

General Provider Information

NPI Number	:	1770679227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN L COKER M.S., CCC/SLP

Provider Business Mailing Address
First Line	:	17 LUCAS LANE
Second Line	:
City	:	BOWDOINHAM
State	:	ME
Zip	:	04008-4021
Country	:	US
Telephone Number	:	207-666-8904
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 LUCAS LANE
Second Line	:
City	:	BOWDOINHAM
State	:	ME
Zip	:	04008-4021
Country	:	US
Telephone Number	:	207-666-8904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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