Provider Demographics
NPI:1073922308
Name:KOLE, CHERYL MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:KOLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-6759
Mailing Address - Country:US
Mailing Address - Phone:863-414-6496
Mailing Address - Fax:
Practice Address - Street 1:943 MALL RING RD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8515
Practice Address - Country:US
Practice Address - Phone:863-402-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist