Provider Demographics
NPI:1881938132
Name:COLE, CAROL MOORE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MOORE
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 S IRONTON ST
Mailing Address - Street 2:# 201
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2011
Mailing Address - Country:US
Mailing Address - Phone:828-513-7279
Mailing Address - Fax:
Practice Address - Street 1:456 S IRONTON ST
Practice Address - Street 2:# 201
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2011
Practice Address - Country:US
Practice Address - Phone:828-513-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1030574224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant