Provider Demographics
NPI:1548270135
Name:COLE ORTHOTICS AND PROSTHETICS CENTER
Entity type:Organization
Organization Name:COLE ORTHOTICS AND PROSTHETICS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED ORTHOTIST
Authorized Official - Phone:419-476-4248
Mailing Address - Street 1:723 PHILLIPS AVE BLDG F
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1351
Mailing Address - Country:US
Mailing Address - Phone:419-476-4248
Mailing Address - Fax:419-476-6655
Practice Address - Street 1:723 PHILLIPS AVE
Practice Address - Street 2:BLDG F
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612
Practice Address - Country:US
Practice Address - Phone:419-476-4248
Practice Address - Fax:419-476-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1122663Medicaid
OH0192370001Medicare NSC