Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1891940185 |
---|---|
Provider Name | Mrs. Amanda Marie Cole |
First Address | North Chicago, IL 60064-3048 |
Second Address | North Chicago, IL 60064-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2008 |
Last Update Date | 01/12/2008 |