Provider Demographics
NPI:1265674410
Name:COQUYT, JOLAYN MARIE (OT)
Entity Type:Individual
Prefix:MS
First Name:JOLAYN
Middle Name:MARIE
Last Name:COQUYT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-5800
Mailing Address - Country:US
Mailing Address - Phone:605-987-2655
Mailing Address - Fax:605-987-5631
Practice Address - Street 1:440 N HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-5800
Practice Address - Country:US
Practice Address - Phone:605-987-2655
Practice Address - Fax:605-987-5631
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist