Provider Demographics
NPI:1013709583
Name:COTTER, CARLEEN
Entity type:Individual
Prefix:
First Name:CARLEEN
Middle Name:
Last Name:COTTER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 E KLEINDALE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1328
Mailing Address - Country:US
Mailing Address - Phone:510-517-7959
Mailing Address - Fax:
Practice Address - Street 1:10 PIER 1 STE 308
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6338
Practice Address - Country:US
Practice Address - Phone:503-974-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC224786171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist