Provider Demographics
NPI:1326031410
Name:COLE, DANIEL (CO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 PHILLIPS AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1362
Mailing Address - Country:US
Mailing Address - Phone:419-476-4248
Mailing Address - Fax:419-476-6655
Practice Address - Street 1:723 PHILLIPS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1362
Practice Address - Country:US
Practice Address - Phone:419-476-4248
Practice Address - Fax:419-476-6655
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLO207222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1122663Medicaid
OH1122663Medicaid