Provider Demographics
NPI:1609021948
Name:COTTRELL, FORREST LEE (CMT)
Entity Type:Individual
Prefix:MR
First Name:FORREST
Middle Name:LEE
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:MR
Other - First Name:FORREST
Other - Middle Name:LEE
Other - Last Name:COTTRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:406 14TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-2313
Mailing Address - Country:US
Mailing Address - Phone:707-502-4126
Mailing Address - Fax:
Practice Address - Street 1:406 14TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2313
Practice Address - Country:US
Practice Address - Phone:707-502-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other