Individual
MR. COLT KEITH CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.O.T.A.
Contact information
Practice address
9730 PRAIRIE LAKES BLVD E, NOBLESVILLE, IN 46060-4766
(317) 770-3644
Mailing address
6035 MILL OAK DR., NOBLESVILLE, IN 46062
(812) 661-0009
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001386A
IN
Other
Enumeration date
09/18/2009
Last updated
10/09/2012
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