Provider Demographics
NPI:1124621545
Name:COOGLE, CARL LEE
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:LEE
Last Name:COOGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18933 PINKLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-9363
Mailing Address - Country:US
Mailing Address - Phone:740-390-9746
Mailing Address - Fax:
Practice Address - Street 1:18933 PINKLEY RD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-9363
Practice Address - Country:US
Practice Address - Phone:740-390-9746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS890181347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle