Provider Demographics
NPI:1780874230
Name:COLE, ROSA M (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94736 SCOUTS VIEW
Mailing Address - Street 2:
Mailing Address - City:PISTOL RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97444-1569
Mailing Address - Country:US
Mailing Address - Phone:541-373-0381
Mailing Address - Fax:
Practice Address - Street 1:94736 SCOUTS VIEW
Practice Address - Street 2:
Practice Address - City:PISTOL RIVER
Practice Address - State:OR
Practice Address - Zip Code:97444
Practice Address - Country:US
Practice Address - Phone:541-373-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR320777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist