Provider Demographics
NPI:1407019409
Name:COLE, SUSAN E (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:COLE
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 1:743 S BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1005
Mailing Address - Country:US
Mailing Address - Phone:419-382-7400
Mailing Address - Fax:419-382-9170
Practice Address - Street 1:743 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-1005
Practice Address - Country:US
Practice Address - Phone:419-382-7400
Practice Address - Fax:419-382-9170
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9037225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$-00OtherOHIO BWC