Provider Demographics
NPI:1770847048
Name:COTTON, BILLY
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:COTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 N LAMB BLVD
Mailing Address - Street 2:#113
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2306
Mailing Address - Country:US
Mailing Address - Phone:702-772-2727
Mailing Address - Fax:
Practice Address - Street 1:867 N LAMB BLVD
Practice Address - Street 2:#113
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2306
Practice Address - Country:US
Practice Address - Phone:702-772-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty