Provider Demographics
NPI:1285042705
Name:COLE, TAMARA D (PERSONAL CARE PROVID)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:D
Last Name:COLE
Suffix:
Gender:F
Credentials:PERSONAL CARE PROVID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5984 COUNTY ROAD C
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-9627
Mailing Address - Country:US
Mailing Address - Phone:419-583-7786
Mailing Address - Fax:419-822-0251
Practice Address - Street 1:5984 COUNTY ROAD C
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-9627
Practice Address - Country:US
Practice Address - Phone:419-583-7786
Practice Address - Fax:419-822-0251
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3026611Medicaid