Healthcare Provider Details

I. General information

NPI: 1922243898
Provider Name (Legal Business Name): ELIZABETH MARIE COLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 ARBOR ST
OMAHA NE
68144-2981
US

IV. Provider business mailing address

1804 PADMAVANI LN CONDO C
FAIRFIELD IA
52556-9090
US

V. Phone/Fax

Practice location:
  • Phone: 800-334-1919
  • Fax:
Mailing address:
  • Phone: 641-472-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number00366
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: