Provider Demographics
NPI:1518324136
Name:COLEMAN, CARRIE MICHELLE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MICHELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:COLEMAN
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:377 CLONCE ST
Mailing Address - Street 2:
Mailing Address - City:WEBER CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24290-7269
Mailing Address - Country:US
Mailing Address - Phone:276-488-5640
Mailing Address - Fax:276-386-2597
Practice Address - Street 1:377 CLONCE ST
Practice Address - Street 2:
Practice Address - City:WEBER CITY
Practice Address - State:VA
Practice Address - Zip Code:24290-7269
Practice Address - Country:US
Practice Address - Phone:276-477-5640
Practice Address - Fax:276-386-2597
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006055225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist