Healthcare Provider Details

I. General information

NPI: 1477943363
Provider Name (Legal Business Name): CHRYSTAN NICOLE COTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 VAUGHN PLAZA RD STE G
MONTGOMERY AL
36116-1141
US

IV. Provider business mailing address

2801 VAUGHN PLAZA RD STE G
MONTGOMERY AL
36116-1141
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-3888
  • Fax: 334-356-3888
Mailing address:
  • Phone: 334-356-3888
  • Fax: 334-356-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number241880
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: