Healthcare Provider Details

I. General information

NPI: 1255929881
Provider Name (Legal Business Name): TONYA NICOLE COTTLES-TOWNSEL HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 MALL RD
FLORENCE AL
35630-2809
US

IV. Provider business mailing address

2479 MALL RD
FLORENCE AL
35630-2809
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-8108
  • Fax:
Mailing address:
  • Phone: 256-766-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2309
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: