MEDICARE: ELIZABETH MARIE COLE OTR/L

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	225XG0600X	Gerontology Occupational Therapist	00366	IA

General Provider Information

NPI Number	:	1922243898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARIE COLE OTR/L

Provider Business Mailing Address
First Line	:	1804 PADMAVANI LN
Second Line	:	CONDO C
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-9090
Country	:	US
Telephone Number	:	641-472-2966
Fax Number	:

Provider Business Practice Location Address
First Line	:	11623 ARBOR ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2981
Country	:	US
Telephone Number	:	800-334-1919
Fax Number	:

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/08/2008

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