Provider Demographics
NPI:1598458119
Name:COLEMAN, KRYSTAIN NOEL (OTD, OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:KRYSTAIN
Middle Name:NOEL
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RIVER RD APT N106
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-1356
Mailing Address - Country:US
Mailing Address - Phone:256-815-3393
Mailing Address - Fax:
Practice Address - Street 1:130 RIVER RD APT N106
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-1356
Practice Address - Country:US
Practice Address - Phone:256-815-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5730225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist