Provider Demographics
NPI:1649504697
Name:COTTLE, ELAINE
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
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 1:138 STORMVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6336
Mailing Address - Country:US
Mailing Address - Phone:914-737-4400
Mailing Address - Fax:
Practice Address - Street 1:138 STORMVILLE RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-6336
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004112-1101YM0800X
NY225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health