Provider Demographics
NPI:1942751714
Name:COKER, EDMOND THOMAS (COTA/L)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:THOMAS
Last Name:COKER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LINKS VIEW CT
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4752
Mailing Address - Country:US
Mailing Address - Phone:478-447-2390
Mailing Address - Fax:
Practice Address - Street 1:104 LINKS VIEW CT
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-4752
Practice Address - Country:US
Practice Address - Phone:478-447-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA362282224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant