MEDICARE: VICTORIA DANIELLE 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
1	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1063150340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA DANIELLE COTTON

Provider Business Mailing Address
First Line	:	261 N LAMB BLVD UNIT B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-0505
Country	:	US
Telephone Number	:	314-574-8970
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 N LAMB BLVD UNIT B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-0505
Country	:	US
Telephone Number	:	314-574-8970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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Directions to “ VICTORIA DANIELLE COTTON ” Practice Location

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