Provider Demographics
NPI:1588938005
Name:COTTON, SUSAN ELAINE (CMF,COF)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:COTTON
Suffix:
Gender:F
Credentials:CMF,COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 SONOMA HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4240
Mailing Address - Country:US
Mailing Address - Phone:707-539-5151
Mailing Address - Fax:707-539-7145
Practice Address - Street 1:4975 SONOMA HWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4240
Practice Address - Country:US
Practice Address - Phone:707-539-5151
Practice Address - Fax:707-539-7145
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter