Provider Demographics
NPI:1790802460
Name:COTTRILL, TERESA LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LEE
Last Name:COTTRILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 LUSITANO LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-6893
Mailing Address - Country:US
Mailing Address - Phone:304-839-5117
Mailing Address - Fax:
Practice Address - Street 1:136 LUSITANO LN
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-6893
Practice Address - Country:US
Practice Address - Phone:304-839-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22129164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse