Provider Demographics
NPI:1205419132
Name:DENISE, COLE ANTHONY
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:ANTHONY
Last Name:DENISE
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-0188
Mailing Address - Country:US
Mailing Address - Phone:937-622-0157
Mailing Address - Fax:
Practice Address - Street 1:550 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-9540
Practice Address - Country:US
Practice Address - Phone:937-465-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator