Provider Demographics
NPI:1386187003
Name:COLEMAN, JOHN (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
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 1:626 N TEJON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1079
Mailing Address - Country:US
Mailing Address - Phone:618-334-6610
Mailing Address - Fax:
Practice Address - Street 1:626 N TEJON ST APT 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1079
Practice Address - Country:US
Practice Address - Phone:618-334-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000732224Z00000X
IL057004395224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant