Provider Demographics
NPI:1053488031
Name:COFER, ANTONIO (OT)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:COFER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4814
Mailing Address - Country:US
Mailing Address - Phone:912-355-0123
Mailing Address - Fax:912-355-3856
Practice Address - Street 1:911 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4814
Practice Address - Country:US
Practice Address - Phone:912-355-0123
Practice Address - Fax:912-355-3856
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT000905OtherSTATE BOARD OT
GAGRP4127Medicare ID - Type UnspecifiedMEDICARE GROUP
GA67BBBGKMedicare ID - Type UnspecifiedINDIVIDUAL