Provider Demographics
NPI:1962872127
Name:COLEMAN, JEANNE (PTA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HOVEY POND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1577
Mailing Address - Country:US
Mailing Address - Phone:508-320-2411
Mailing Address - Fax:
Practice Address - Street 1:206 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1733
Practice Address - Country:US
Practice Address - Phone:617-527-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8717171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor