Provider Demographics
NPI:1407188824
Name:COLEMAN, DAPHNE NICOLE (OTR)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:NICOLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 BLUECUTT RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1305
Mailing Address - Country:US
Mailing Address - Phone:662-327-5557
Mailing Address - Fax:662-327-5834
Practice Address - Street 1:2309 BLUECUTT RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1305
Practice Address - Country:US
Practice Address - Phone:662-327-5557
Practice Address - Fax:662-327-5834
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist