Provider Demographics
NPI:1447468509
Name:COLE, JOAN E (LMP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:COLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 CORONA ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-4807
Mailing Address - Country:US
Mailing Address - Phone:360-385-5068
Mailing Address - Fax:
Practice Address - Street 1:2041 E SIMS WAY
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6905
Practice Address - Country:US
Practice Address - Phone:360-379-0800
Practice Address - Fax:360-343-1003
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016328225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203425OtherDEPT OF LABOR & INDUSTRIE
WA912025809-07OtherKPS HEALTH PLANS
WA09038OtherFIRST CHOICE HEALTH