Provider Demographics
NPI:1083912752
Name:COAD, KRISTIN JOY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:JOY
Last Name:COAD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6746 W COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3876
Mailing Address - Country:US
Mailing Address - Phone:904-535-5604
Mailing Address - Fax:
Practice Address - Street 1:5899 WHITFIELD AVE
Practice Address - Street 2:#203
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-6152
Practice Address - Country:US
Practice Address - Phone:904-535-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9969224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant