1104101534 NPI number — MRS. BETTY JEAN NAYLOR COTA/L

Table of content: MRS. BETTY JEAN NAYLOR COTA/L (NPI 1104101534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104101534 NPI number — MRS. BETTY JEAN NAYLOR COTA/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAYLOR
Provider First Name:
BETTY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104101534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10407-1 N. 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85020-8544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-619-9565
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 JACKS CANYON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEDONA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86351-7856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-284-2411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  2046 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)