Healthcare Provider Details

I. General information

NPI: 1417697962
Provider Name (Legal Business Name): JAMARLOWE COTTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 N 61ST ST
MILWAUKEE WI
53210-2110
US

IV. Provider business mailing address

2740 N 61ST ST
MILWAUKEE WI
53210-2110
US

V. Phone/Fax

Practice location:
  • Phone: 414-334-3054
  • Fax:
Mailing address:
  • Phone: 414-334-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: