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General NPI Number Information
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NPI Number | 1659146116
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Entity Type | Individual
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Provider Name | CHRISTIAN JEAN COTTRELL LMT
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Gender | Male
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 101 SE 9TH ST
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City | MULDROW
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State | OK
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Zip | 74948-4111
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Country | US
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Telephone | 479-883-9390
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Fax |
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Provider Business Mailing Address
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Address Line | 473591 E 1097 RD
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City | MULDROW
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State | OK
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Zip | 74948-7227
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Country | US
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Telephone | 918-772-8272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 198440
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License Number State | OK
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