Provider Demographics
NPI:1487336673
Name:COLEMAN, NIKESE D (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:NIKESE
Middle Name:D
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 KYMULGA RD
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-5419
Mailing Address - Country:US
Mailing Address - Phone:205-531-0924
Mailing Address - Fax:
Practice Address - Street 1:1855 KYMULGA RD
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-5419
Practice Address - Country:US
Practice Address - Phone:205-531-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6845225X00000X
TX121694225X00000X
AL3577225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist