Basic Information
| Provider Information | |||||||||
| NPI: | 1780276956 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COTTLE | ||||||||
| FirstName: | HAYLEY | ||||||||
| MiddleName: | MADISON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 DOCK HILL RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178428910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708372123 | ||||||||
| FaxNumber: | 5708372185 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 FORGE RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | BOILING SPRINGS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170079787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172546109 | ||||||||
| FaxNumber: | 7177018522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2021 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1039169000001 | 05 | PA | MEDICAID | 1S9361 | 01 | PA | MEDICARE | OTHER |