Provider Demographics
NPI:1720042815
Name:COTTINGHAM, MARIAN RENEE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:RENEE
Last Name:COTTINGHAM
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:RENEE
Other - Last Name:NADOLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:13350 24 MILE RD
Practice Address - Street 2:STE 500
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-1827
Practice Address - Country:US
Practice Address - Phone:586-997-7780
Practice Address - Fax:586-997-7781
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011020208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501011020OtherSTATE LICENSE #
MIMI6211114Medicare PIN