Provider Demographics
NPI:1558633305
Name:COLEMAN, SAMANTHAI J (COTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHAI
Middle Name:J
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W COMPROMISE ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711
Mailing Address - Country:US
Mailing Address - Phone:260-385-0286
Mailing Address - Fax:
Practice Address - Street 1:423 W COMPROMISE ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1421
Practice Address - Country:US
Practice Address - Phone:260-385-0286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001874A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant