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Individual

COBY A BAMFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DTR

Contact information

Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-9800
(570) 214-1077
Mailing address
2110 PULASKI AVE, COAL TOWNSHIP, PA 17866-4056
(570) 809-1588

Taxonomy

Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary

Other

Enumeration date
03/09/2020
Last updated
03/09/2020
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