Healthcare Provider Details

I. General information

NPI: 1033554019
Provider Name (Legal Business Name): MS. JOLITA ANTOINETTE COTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 E VERNOR HWY APT 202
DETROIT MI
48207-5179
US

IV. Provider business mailing address

2660 E VERNOR HWY APT 202
DETROIT MI
48207-5179
US

V. Phone/Fax

Practice location:
  • Phone: 313-739-3647
  • Fax:
Mailing address:
  • Phone: 313-739-3647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: