1366595761 NPI number — MRS. MARGARET THOM COTTON SLP

Table of content: MRS. MARGARET THOM COTTON SLP (NPI 1366595761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366595761 NPI number — MRS. MARGARET THOM COTTON SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COTTON
Provider First Name:
MARGARET
Provider Middle Name:
THOM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
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:
1366595761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3073 W CANYON BROOK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85742-8708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-370-2352
Provider Business Mailing Address Fax Number:
520-544-9497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7368 N. LA CHOLLA BLVD
Provider Second Line Business Practice Location Address:
PANACEA THERAPEUTICS
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85741-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-370-2352
Provider Business Practice Location Address Fax Number:
520-544-9497
Provider Enumeration Date:
01/19/2007

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: 235Z00000X , with the licence number:  SLP1078 , 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)

  • Identifier: SLP1078 . This is a "HEALTH LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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