Healthcare Provider Details

I. General information

NPI: 1235058645
Provider Name (Legal Business Name): COLE ELDRIDGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 HAMILTON RD STE 345
OKEMOS MI
48864-1954
US

IV. Provider business mailing address

1256 N SHEPARDSVILLE RD
OVID MI
48866-9657
US

V. Phone/Fax

Practice location:
  • Phone: 517-708-0017
  • Fax:
Mailing address:
  • Phone: 860-938-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501010754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: