Provider Demographics
NPI: | 1164692190 |
---|---|
Name: | COLE, ROBERTA LOUISE (CRT) |
Entity Type: | Individual |
Prefix: | |
First Name: | ROBERTA |
Middle Name: | LOUISE |
Last Name: | COLE |
Suffix: | |
Gender: | F |
Credentials: | CRT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1100 W QUINN RD APT 23 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHUBBUCK |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83202-2451 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-241-1982 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 651 MEMORIAL DR |
Practice Address - Street 2: | |
Practice Address - City: | POCATELLO |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83201-4071 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-239-1372 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-03-05 |
Last Update Date: | 2008-03-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ID | LRT-1077 | 2278G1100X, 2278C0205X, 2278E0002X, 2278G0305X, 2278H0200X, 2278P3800X, 2278S1500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2278G1100X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | General Care |
No | 2278C0205X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Critical Care |
No | 2278E0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Emergency Care |
No | 2278G0305X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Geriatric Care |
No | 2278H0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Home Health |
No | 2278P3800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Palliative/Hospice |
No | 2278S1500X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | SNF/Subacute Care |