Provider Demographics
NPI:1194549832
Name:COOMES, MADISON COLETTE (CTRS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:COLETTE
Last Name:COOMES
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 BARRITT ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3631
Mailing Address - Country:US
Mailing Address - Phone:517-862-7741
Mailing Address - Fax:
Practice Address - Street 1:2125 BARRITT ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3631
Practice Address - Country:US
Practice Address - Phone:517-862-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI81534225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist