Provider Demographics
NPI:1609297993
Name:COLEMAN, LA JEIM ILESE (OTR)
Entity Type:Individual
Prefix:
First Name:LA JEIM
Middle Name:ILESE
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 1:763 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3730
Mailing Address - Country:US
Mailing Address - Phone:215-703-7305
Mailing Address - Fax:
Practice Address - Street 1:763 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3730
Practice Address - Country:US
Practice Address - Phone:215-703-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013176225X00000X
VA0119006156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist