MEDICARE: MRS. MARION MULLRAY 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	171W00000X	Contractor	OP000719L	PA

General Provider Information

NPI Number	:	1013240530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARION MULLRAY COTA/L

Provider Business Mailing Address
First Line	:	1111 AIRPORT RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4048
Country	:	US
Telephone Number	:	610-436-0941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 AIRPORT RD
Second Line	:	705 N FRANKLIN ST
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4048
Country	:	US
Telephone Number	:	610-436-0941
Fax Number	:

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

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/16/2009

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