MEDICARE: COLLEEN COTTER

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	164W00000X	Licensed Practical Nurse	156850	OH

General Provider Information

NPI Number	:	1922573732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN COTTER

Provider Business Mailing Address
First Line	:	5233 E 113TH ST
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2736
Country	:	US
Telephone Number	:	216-213-1187
Fax Number	:

Provider Business Practice Location Address
First Line	:	5233 E 113TH ST
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2736
Country	:	US
Telephone Number	:	216-213-1187
Fax Number	:

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

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	10/08/2018

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Directions to “ COLLEEN COTTER ” Practice Location

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