Provider Demographics
NPI:1114409224
Name:COTTON, BETTY JEAN
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:COTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 FM 27 W
Mailing Address - Street 2:
Mailing Address - City:STREETMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75859-5265
Mailing Address - Country:US
Mailing Address - Phone:254-640-0281
Mailing Address - Fax:
Practice Address - Street 1:601 E REUNION ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-1634
Practice Address - Country:US
Practice Address - Phone:254-640-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012464225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant