Provider Demographics
NPI:1689970816
Name:COTTRILL, TRAVIS ALLEN (RN)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:ALLEN
Last Name:COTTRILL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 OHIO AVE.
Mailing Address - Street 2:
Mailing Address - City:NUTTER FORT
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4502
Mailing Address - Country:US
Mailing Address - Phone:304-695-0631
Mailing Address - Fax:
Practice Address - Street 1:90 OHIO AVE.
Practice Address - Street 2:
Practice Address - City:NUTTER FORT
Practice Address - State:WV
Practice Address - Zip Code:26301-4502
Practice Address - Country:US
Practice Address - Phone:304-695-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV73300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse