MEDICARE: MRS. SHARON ELIZABETH COTTLE MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3178813501	UT

General Provider Information

NPI Number	:	1801971759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON ELIZABETH COTTLE MSW

Provider Business Mailing Address
First Line	:	1190 N 900 E
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6709
Country	:	US
Telephone Number	:	801-422-7620
Fax Number	:	801-422-0165

Provider Business Practice Location Address
First Line	:	1190 N 900 E
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6709
Country	:	US
Telephone Number	:	801-422-7620
Fax Number	:	801-422-0165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	11/25/2009

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