Provider Demographics
NPI:1205873213
Name:COTTLE, TIARA L
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:L
Last Name:COTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3834
Mailing Address - Country:US
Mailing Address - Phone:786-439-5550
Mailing Address - Fax:888-335-8617
Practice Address - Street 1:2814 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3834
Practice Address - Country:US
Practice Address - Phone:786-439-5550
Practice Address - Fax:888-335-8617
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9306235Z00000X
FLSZ3905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA 9306OtherDEPARTMENT OF HEALTH
FL891202501Medicaid
MD12080616OtherAMERICAN SPEECH AND HEARING ASSOCIATION
FL891202500Medicaid