Provider Demographics
NPI:1699947390
Name:COLE, SCOTT WILLIAM WALLACE (ATC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WILLIAM WALLACE
Last Name:COLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:008 HPC
Mailing Address - Street 2:UNIVERSITY OF NORTHERN IOWA
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-0314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:008 HPC
Practice Address - Street 2:UNIVERSITY OF NORTHERN IOWA
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0314
Practice Address - Country:US
Practice Address - Phone:715-498-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0006642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer