Provider Demographics
NPI:1750848982
Name:COLE, KATHRYN ALEXANDRIA (ATC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALEXANDRIA
Last Name:COLE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 NE HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3503
Mailing Address - Country:US
Mailing Address - Phone:541-761-7902
Mailing Address - Fax:
Practice Address - Street 1:1403 NE HERITAGE DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3503
Practice Address - Country:US
Practice Address - Phone:541-761-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20000349462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer