Provider Demographics
NPI:1457442287
Name:COLEMAN, THOMAS (OT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORT READING
Mailing Address - State:NJ
Mailing Address - Zip Code:07064-1808
Mailing Address - Country:US
Mailing Address - Phone:732-221-7271
Mailing Address - Fax:
Practice Address - Street 1:122 1ST AVE
Practice Address - Street 2:
Practice Address - City:PORT READING
Practice Address - State:NJ
Practice Address - Zip Code:07064-1808
Practice Address - Country:US
Practice Address - Phone:732-221-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00298700225X00000X
NY010905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist