Deloris Cotton-Smith
Individual provider Active NPI Contractor · Trotwood, OH
NPI 1497178651 · NPPES record last updated Jan 23, 2014
Key facts
- NPI
- 1497178651
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 171W00000X-CONTRACTO (OH)
- Practice address
- 4625 Knollcroft Rd
Trotwood, OH 45426-1938 - Phone
- (937) 837-3561
- NPI assigned
- Jan 23, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 171W00000X-CONTRACTO | OH | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 171W00000X-CONTRACTO | OH | Yes |
Addresses
Primary practice location
4625 Knollcroft Rd
Trotwood, OH 45426-1938
Mailing address
4625 Knollcroft Rd
Trotwood, OH 45426-1938
Phone (937) 837-3561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105865396399 | Medicaid | OH |
Other providers in Trotwood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.