Provider Demographics
NPI:1710610175
Name:COTHAM, CHUTIKARN
Entity type:Individual
Prefix:
First Name:CHUTIKARN
Middle Name:
Last Name:COTHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHUTIKARN
Other - Middle Name:
Other - Last Name:MANAYARNKIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 KEETON CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 KEETON CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2271
Practice Address - Country:US
Practice Address - Phone:512-767-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool