Provider Demographics
NPI:1699940296
Name:COOLIDGE, CAROLYN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:COOLIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42745 25TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3932
Mailing Address - Country:US
Mailing Address - Phone:661-917-0546
Mailing Address - Fax:
Practice Address - Street 1:6055 E. WASHINGTONBLVD.
Practice Address - Street 2:SUITE 900
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:323-346-0966
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner