Provider Demographics
NPI:1215389028
Name:COLEMAN, CHYNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHYNA
Middle Name:
Last Name:COLEMAN
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 1:2915 E BASELINE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2425
Mailing Address - Country:US
Mailing Address - Phone:480-855-8866
Mailing Address - Fax:
Practice Address - Street 1:2915 E BASELINE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2425
Practice Address - Country:US
Practice Address - Phone:480-855-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6613225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
359505OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY