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General NPI Number Information
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NPI Number | 1124854997
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Entity Type | Individual
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Provider Name | MRS. JESSICA COLE
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Gender | Female
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 2655 N STATE ROAD 127
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City | ANGOLA
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State | IN
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Zip | 46703-7519
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Country | US
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Telephone | 517-278-2519
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Fax |
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Provider Business Mailing Address
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Address Line | 408 FOX RD
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City | COLDWATER
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State | MI
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Zip | 49036-9483
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Country | US
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Telephone | 517-278-2519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT22408272
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License Number State | IN
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