Provider Demographics
NPI:1962165050
Name:COFFMAN, EMILY ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:COFFMAN
Suffix:
Gender:F
Credentials: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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-0188
Mailing Address - Country:US
Mailing Address - Phone:724-809-1477
Mailing Address - Fax:
Practice Address - Street 1:10 N ROCK GLEN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3250
Practice Address - Country:US
Practice Address - Phone:724-809-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09431225X00000X
PAOC017975225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist