Individual
LATARSHA COTTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 PINE GROVE DR, BROCKTON, MA 02301-1115
(857) 249-4635
Mailing address
80 PINE GROVE DR, BROCKTON, MA 02301-1115
(857) 249-4635
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S77827947
MASS ID
MA
Enumeration date
06/16/2018
Last updated
06/16/2018
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