Individual
DELORIS COTTON-SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4625 KNOLLCROFT RD, TROTWOOD, OH 45426-1938
(937) 837-3561
Mailing address
4625 KNOLLCROFT RD, TROTWOOD, OH 45426-1938
(937) 837-3561
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171W00000X-CONTRACTO
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105865396399
—
OH
Enumeration date
01/23/2014
Last updated
01/23/2014
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