Individual
SUSAN M COYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2305 SAN LUIS PL, GREEN BAY, WI 54304-5211
(920) 494-5231
Mailing address
12 CENTURY CT, APPLETON, WI 54914-6403
(920) 740-8441
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
183-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
183-27
WI LICENSE
WI
Enumeration date
07/25/2013
Last updated
07/25/2013
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