Provider Demographics
NPI:1548885031
Name:KOTKIN, BRETA (MAOM, LIC AC)
Entity type:Individual
Prefix:
First Name:BRETA
Middle Name:
Last Name:KOTKIN
Suffix:
Gender:F
Credentials:MAOM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9089
Mailing Address - Country:US
Mailing Address - Phone:207-883-5549
Mailing Address - Fax:
Practice Address - Street 1:433 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9089
Practice Address - Country:US
Practice Address - Phone:207-883-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist