Healthcare Provider Details

I. General information

NPI: 1588938005
Provider Name (Legal Business Name): SUSAN ELAINE COTTON C.M.F.,C.O.F
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4975 SONOMA HWY
SANTA ROSA CA
95409-4240
US

IV. Provider business mailing address

4975 SONOMA HWY
SANTA ROSA CA
95409-4240
US

V. Phone/Fax

Practice location:
  • Phone: 707-539-5151
  • Fax: 707-539-7145
Mailing address:
  • Phone: 707-539-5151
  • Fax: 707-539-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: