Provider Demographics
NPI:1649004326
Name:COLE, TODDRA DENAY
Entity type:Individual
Prefix:
First Name:TODDRA
Middle Name:DENAY
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5252
Mailing Address - Country:US
Mailing Address - Phone:337-831-4905
Mailing Address - Fax:
Practice Address - Street 1:116 W BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5252
Practice Address - Country:US
Practice Address - Phone:337-831-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator