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General NPI Number Information
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NPI Number | 1790500676
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Entity Type | Individual
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Provider Name | JAMIE COLE
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4555 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2102
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Country | US
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Telephone | 773-328-8153
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Fax |
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Provider Business Mailing Address
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Address Line | 3123 HOLDEN CIR
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City | MATTESON
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State | IL
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Zip | 60443-4430
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Country | US
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Telephone | 708-261-7488
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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 | 227023204
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License Number State | IL
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