Provider Demographics
NPI:1417630880
Name:COTTLE, SHAREA LYNN
Entity Type:Individual
Prefix:
First Name:SHAREA
Middle Name:LYNN
Last Name:COTTLE
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 1:23 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1938
Mailing Address - Country:US
Mailing Address - Phone:866-632-0793
Mailing Address - Fax:
Practice Address - Street 1:23 W MARKET ST
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1938
Practice Address - Country:US
Practice Address - Phone:866-632-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA25341705172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver