Provider Demographics
NPI:1649789637
Name:BRUN-COTTAN, NICOLE (DPT)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BRUN-COTTAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 SE 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3519
Mailing Address - Country:US
Mailing Address - Phone:707-889-1471
Mailing Address - Fax:
Practice Address - Street 1:210 W 4TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3493
Practice Address - Country:US
Practice Address - Phone:360-258-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR624792251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology