Provider Demographics
NPI:1649516758
Name:COLE, JESSICA MARIE (MS, ATC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 TRELLIS WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1543
Mailing Address - Country:US
Mailing Address - Phone:734-945-4244
Mailing Address - Fax:
Practice Address - Street 1:700 PARK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-8050
Practice Address - Country:US
Practice Address - Phone:757-823-9547
Practice Address - Fax:757-823-2316
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260011872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer