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NPI Code Detail

MEDICARE: KELLY COTTON

MEDICARE: KELLY COTTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1003097098
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY COTTON
Provider Business Mailing Address
First Line : 555 AMORY ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-2652
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 555 AMORY ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-2652
Country : US
Telephone Number : 617-383-6522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2007
Last Update Date : 11/18/2007

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Directions to “ KELLY COTTON ” Practice Location

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