Provider Demographics
NPI:1578323960
Name:KOTULA, CHRISTIN (LMT #670)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:KOTULA
Suffix:
Gender:F
Credentials:LMT #670
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 BAYOU PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-7907
Mailing Address - Country:US
Mailing Address - Phone:228-234-7131
Mailing Address - Fax:
Practice Address - Street 1:6819 WASHINGTON AVE STE F
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2181
Practice Address - Country:US
Practice Address - Phone:228-697-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist