Provider Demographics
NPI:1487791513
Name:COBLE, HOLLY ANNETTE (HHA)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANNETTE
Last Name:COBLE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 LUDWIG AVE
Mailing Address - Street 2:
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431-1212
Mailing Address - Country:US
Mailing Address - Phone:419-307-5919
Mailing Address - Fax:
Practice Address - Street 1:613 LUDWIG AVE
Practice Address - Street 2:
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431-1212
Practice Address - Country:US
Practice Address - Phone:419-307-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2066839Medicaid