Provider Demographics
NPI:1619657012
Name:DEARING, COLE EDWARD (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:EDWARD
Last Name:DEARING
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13720 STATE ROUTE 292
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-9064
Mailing Address - Country:US
Mailing Address - Phone:567-674-4267
Mailing Address - Fax:
Practice Address - Street 1:13720 STATE ROUTE 292
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-9064
Practice Address - Country:US
Practice Address - Phone:567-674-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
390200000X
OHAT0069792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program