Provider Demographics
NPI:1659146116
Name:COTTRELL, CHRISTIAN JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JEAN
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473591 E 1097 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-7227
Mailing Address - Country:US
Mailing Address - Phone:918-772-8272
Mailing Address - Fax:
Practice Address - Street 1:101 SE 9TH ST
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-4111
Practice Address - Country:US
Practice Address - Phone:479-883-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK198440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist