MEDICARE: MRS. EILEEN FAITH FLAX 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
1	224Z00000X	Occupational Therapy Assistant	46TA09037100	NJ

General Provider Information

NPI Number	:	1427209824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EILEEN FAITH FLAX COTA/L

Provider Business Mailing Address
First Line	:	121 CROMWELL DR
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062-1808
Country	:	US
Telephone Number	:	856-223-1137
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 CROMWELL DR
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062-1808
Country	:	US
Telephone Number	:	856-223-1137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/02/2008

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