Provider Demographics
NPI:1538100680
Name:COTTENGAIN112954, DEBORAH LYNN
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:COTTENGAIN112954
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 1:3305 CHIEF TARKEE CT
Mailing Address - Street 2:3305 CHIEF TARKEE CT
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-9578
Mailing Address - Country:US
Mailing Address - Phone:937-497-8485
Mailing Address - Fax:
Practice Address - Street 1:3306 CHIEF TARKEE CT
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-9578
Practice Address - Country:US
Practice Address - Phone:937-492-5859
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide