Provider Demographics
NPI:1275948176
Name:STOTLER, CATHERINE (MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:STOTLER
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:KADE
Other - Middle Name:
Other - Last Name:STOTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:362 JACKSON AVE # 318
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80520-5100
Mailing Address - Country:US
Mailing Address - Phone:206-218-6298
Mailing Address - Fax:
Practice Address - Street 1:300 S JACKSON ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3183
Practice Address - Country:US
Practice Address - Phone:720-665-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002563171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist