Provider Demographics
NPI:1689466419
Name:MILKOVICH, COLE EDWARD (OTR/L)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:EDWARD
Last Name:MILKOVICH
Suffix:
Gender:M
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 1:1528 1/2 PACIFIC BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5499
Mailing Address - Country:US
Mailing Address - Phone:818-294-5167
Mailing Address - Fax:
Practice Address - Street 1:865 ANCHORAGE PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4535
Practice Address - Country:US
Practice Address - Phone:818-294-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23717225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics