MEDICARE: MISS KATHERINE ELAINE BENEKER 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	174400000X	Specialist	04808	OH

General Provider Information

NPI Number	:	1467729707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHERINE ELAINE BENEKER COTA/L

Provider Business Mailing Address
First Line	:	230 MAIN ST
Second Line	:	APT B
City	:	NEWPORT
State	:	KY
Zip	:	41071-4840
Country	:	US
Telephone Number	:	513-344-5378
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 MAIN ST
Second Line	:	APT B
City	:	NEWPORT
State	:	KY
Zip	:	41071-4840
Country	:	US
Telephone Number	:	513-344-5378
Fax Number	:

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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Directions to “ MISS KATHERINE ELAINE BENEKER COTA/L” Practice Location

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