MEDICARE: KISIAH COLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1619584299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISIAH COLE

Provider Business Mailing Address
First Line	:	100 RIVERBOAT ROW APT G27
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41071-1053
Country	:	US
Telephone Number	:	513-903-2985
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3236
Country	:	US
Telephone Number	:	513-549-1568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	09/28/2020

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Directions to “ KISIAH COLE ” Practice Location

Language	Start Address	Practice Location

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