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NPI Code Detail

MEDICARE: CHANTEL LEE MCGRADY COTA/L

MEDICARE: CHANTEL LEE MCGRADY COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care FacilityC1791WV

General Provider Information

NPI Number : 1356693600
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANTEL LEE MCGRADY COTA/L
Provider Business Mailing Address
First Line : 210 QUALITY TER
Second Line :
City : MARTINSBURG
State : WV
Zip : 25403-2285
Country : US
Telephone Number : 999-999-9999
Fax Number :
Provider Business Practice Location Address
First Line : 101 E STATE ST
Second Line :
City : KENNETT SQUARE
State : PA
Zip : 19348-3109
Country : US
Telephone Number : 304-298-3602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2012
Last Update Date : 06/15/2026

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