Provider Demographics
NPI:1902667702
Name:COLE, KYLEE SUSAN (MOT, OT/L)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:SUSAN
Last Name:COLE
Suffix:
Gender:F
Credentials:MOT, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WHITE BIRCH LN APT 12
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3655
Mailing Address - Country:US
Mailing Address - Phone:413-834-1538
Mailing Address - Fax:
Practice Address - Street 1:34 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6001
Practice Address - Country:US
Practice Address - Phone:207-241-4583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO4567225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist