Individual
KRYSTAL ANN COOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
585 NUT TREE CT, VACAVILLE, CA 95687-3353
(707) 449-8000
Mailing address
970 SUNSET DR, DIXON, CA 95620-3757
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA3948
CA
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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