Provider Demographics
NPI:1013347061
Name:TOOLE JR., MARK (MT-BC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TOOLE JR.
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHANNA CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2266
Mailing Address - Country:US
Mailing Address - Phone:770-597-5444
Mailing Address - Fax:
Practice Address - Street 1:10 SHANNA CT
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2266
Practice Address - Country:US
Practice Address - Phone:770-597-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist