Individual
COYLE JOHN DOMINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
700 FRANKLIN ST, SOCORRO, NM 87801-4666
(505) 306-4475
Mailing address
11404 FAYE AVE NE, ALBUQUERQUE, NM 87112-5579
(505) 306-4475
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2566
NM
Other
Enumeration date
04/21/2009
Last updated
04/21/2009
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