Healthcare Provider Details

I. General information

NPI: 1285670992
Provider Name (Legal Business Name): JEROD A. COTTRILL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL SUITE 110
VANCOUVER WA
98664-3299
US

IV. Provider business mailing address

710 NE HOLLADAY ST STE 150
PORTLAND OR
97232-2168
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-6161
  • Fax: 360-449-1146
Mailing address:
  • Phone: 503-542-2744
  • Fax: 877-773-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP1945
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDO24951
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: