Provider Demographics
NPI:1053642769
Name:COLEMAN-MCMILLAN, DIANJA E (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANJA
Middle Name:E
Last Name:COLEMAN-MCMILLAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 COACH WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6292
Mailing Address - Country:US
Mailing Address - Phone:770-896-3633
Mailing Address - Fax:
Practice Address - Street 1:719 COACH WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6292
Practice Address - Country:US
Practice Address - Phone:770-896-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist