Provider Demographics
NPI:1407105026
Name:COLEMAN, JEREMY ORANTES (COTA/L)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ORANTES
Last Name:COLEMAN
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 1:1287 CEDAR SHOALS DR APT 1016
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3571
Mailing Address - Country:US
Mailing Address - Phone:706-424-2282
Mailing Address - Fax:
Practice Address - Street 1:1287 CEDAR SHOALS DR APT 1016
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3571
Practice Address - Country:US
Practice Address - Phone:706-424-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA0009313747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant