Provider Demographics
NPI:1972922011
Name:COTHREN, LOUANN
Entity type:Individual
Prefix:
First Name:LOUANN
Middle Name:
Last Name:COTHREN
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 1:501 SW C AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4325
Mailing Address - Country:US
Mailing Address - Phone:580-678-6950
Mailing Address - Fax:
Practice Address - Street 1:501 SW C AVE STE 305
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4325
Practice Address - Country:US
Practice Address - Phone:580-678-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist