Healthcare Provider Details

I. General information

NPI: 1700925187
Provider Name (Legal Business Name): JEFFREY WARREN KOTTER CRTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 FISHERMANS DR APT E
COCONUT CREEK FL
33063-6979
US

IV. Provider business mailing address

4950 FISHERMANS DR APT E
COCONUT CREEK FL
33063-6979
US

V. Phone/Fax

Practice location:
  • Phone: 954-446-4876
  • Fax:
Mailing address:
  • Phone: 954-446-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT11541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: