Provider Demographics
NPI:1215133921
Name:COTTER, EVELYN G (LMP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:G
Last Name:COTTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24481
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-1481
Mailing Address - Country:US
Mailing Address - Phone:253-226-7839
Mailing Address - Fax:253-568-1617
Practice Address - Street 1:500 S 336TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6389
Practice Address - Country:US
Practice Address - Phone:253-226-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023249225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist