Provider Demographics
NPI:1720445216
Name:COLEMAN, MICHELLE ANN (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
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 1:13075 HEATHERSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9051
Mailing Address - Country:US
Mailing Address - Phone:614-208-7380
Mailing Address - Fax:
Practice Address - Street 1:13075 HEATHERSTONE CIR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9051
Practice Address - Country:US
Practice Address - Phone:614-208-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-005171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist