Provider Demographics
NPI:1831590470
Name:COLEY, STEVEN ANTHONY JR
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:COLEY
Suffix:JR
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 1:810 BURKE GLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2507
Mailing Address - Country:US
Mailing Address - Phone:419-329-0340
Mailing Address - Fax:
Practice Address - Street 1:810 BURKE GLEN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-2507
Practice Address - Country:US
Practice Address - Phone:419-329-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401048770310374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide