Provider Demographics
NPI:1720418932
Name:COLEMAN, TA LESHIA
Entity Type:Individual
Prefix:
First Name:TA LESHIA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 NW 39TH STREET
Mailing Address - Street 2:STE #103
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-213-6521
Mailing Address - Fax:405-606-7893
Practice Address - Street 1:2401 NW 39TH STREET
Practice Address - Street 2:STE #103
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-213-6521
Practice Address - Fax:405-606-7893
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator