Provider Demographics
NPI:1750571220
Name:TATE, VIRGINIA COFFMAN (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:COFFMAN
Last Name:TATE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:MISS
Other - First Name:VIRGINIA
Other - Middle Name:NELIA
Other - Last Name:COFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 E FRANKLIN AVE
Mailing Address - Street 2:A
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2312
Mailing Address - Country:US
Mailing Address - Phone:609-730-8320
Mailing Address - Fax:
Practice Address - Street 1:3575 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1205
Practice Address - Country:US
Practice Address - Phone:609-631-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00203700225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics