Healthcare Provider Details

I. General information

NPI: 1508786393
Provider Name (Legal Business Name): ELLEN COTTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8245
US

IV. Provider business mailing address

4095 N RACCOON CIR
MONTICELLO IN
47960-7530
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-7200
  • Fax:
Mailing address:
  • Phone: 574-297-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: