Provider Demographics
NPI:1477943363
Name:COTTON, CHRYSTAN NICOLE
Entity Type:Individual
Prefix:
First Name:CHRYSTAN
Middle Name:NICOLE
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 1:2801 VAUGHN PLAZA RD STE G
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1141
Mailing Address - Country:US
Mailing Address - Phone:334-356-3888
Mailing Address - Fax:334-356-3888
Practice Address - Street 1:2801 VAUGHN PLAZA RD STE G
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1141
Practice Address - Country:US
Practice Address - Phone:334-356-3888
Practice Address - Fax:334-356-3888
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2418801744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management