Individual
MRS. STACEY LYNN COULARDOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2380 N 300 W, BLUFFTON, IN 46714-9734
(260) 694-6318
Mailing address
2380 N 300 W, BLUFFTON, IN 46714-9734
(260) 694-6318
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001396A
IN
Other
Enumeration date
08/26/2008
Last updated
08/26/2008
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