Provider Demographics
NPI:1427541044
Name:COTTLE, REBEKAH F (SLP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:F
Last Name:COTTLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:A
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2227 HIGHWAY 41 NORTH
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-353-3056
Mailing Address - Fax:
Practice Address - Street 1:2227 HIGHWAY 41 NORTH
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-353-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist