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General NPI Number Information
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NPI Number | 1568793792
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Entity Type | Organization
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Legal Business Name | KRISTINA MARIE COTTERMAN
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 6774 ATHENA DR
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City | LAKE WORTH
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State | FL
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Zip | 33463
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Country | US
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Telephone | 561-573-2123
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Fax |
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Provider Business Mailing Address
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Address Line | 6774 ATHENA DR
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City | LAKE WORTH
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State | FL
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Zip | 33463-7286
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Country | US
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Telephone | 561-573-2123
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Fax |
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Authorized Official
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Title or Position | SLP
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Name | MS. KRISTINA MARIE COTTERMAN
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Credential | MA, CCC
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Telephone | 561-673-2123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | SA 9960
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License Number State | FL
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