Provider Demographics
NPI:1639589328
Name:COLE, MADISON (OTR/L)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10894 STATE ROUTE 121 N
Mailing Address - Street 2:
Mailing Address - City:FANCY FARM
Mailing Address - State:KY
Mailing Address - Zip Code:42039-9312
Mailing Address - Country:US
Mailing Address - Phone:270-804-8437
Mailing Address - Fax:
Practice Address - Street 1:10894 STATE ROUTE 121 N
Practice Address - Street 2:
Practice Address - City:FANCY FARM
Practice Address - State:KY
Practice Address - Zip Code:42039-9312
Practice Address - Country:US
Practice Address - Phone:270-804-8437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist