Provider Demographics
NPI:1982296455
Name:COOL, RITA K
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:K
Last Name:COOL
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 1:28 COOL RUN
Mailing Address - Street 2:
Mailing Address - City:HUTTONSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26273-1238
Mailing Address - Country:US
Mailing Address - Phone:304-704-8966
Mailing Address - Fax:
Practice Address - Street 1:28 COOL RUN
Practice Address - Street 2:
Practice Address - City:HUTTONSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26273-1238
Practice Address - Country:US
Practice Address - Phone:304-704-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker