Provider Demographics
NPI:1063271757
Name:COTTON, POLLY A
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:A
Last Name:COTTON
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 1:210 SORENSEN DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8731
Mailing Address - Country:US
Mailing Address - Phone:937-597-0056
Mailing Address - Fax:
Practice Address - Street 1:210 SORENSEN DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8731
Practice Address - Country:US
Practice Address - Phone:937-597-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care