Provider Demographics
NPI:1629479449
Name:KELLIE RAE COOMBS
Entity Type:Organization
Organization Name:KELLIE RAE COOMBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:561-628-3135
Mailing Address - Street 1:43 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2615
Mailing Address - Country:US
Mailing Address - Phone:561-628-3135
Mailing Address - Fax:
Practice Address - Street 1:43 WILLOW RD
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2615
Practice Address - Country:US
Practice Address - Phone:561-628-3135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10741314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility