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NPI Code Detail

MEDICARE: MRS. COURTNEY L MIKESELL COTA

MEDICARE: MRS. COURTNEY L MIKESELL COTA
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
1174400000XSpecialistOP003649LPA

General Provider Information

NPI Number : 1043235856
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COURTNEY L MIKESELL COTA
Provider Business Mailing Address
First Line : 113 N FRONT ST
Second Line :
City : CLEARFIELD
State : PA
Zip : 16830-2512
Country : US
Telephone Number : 814-765-4973
Fax Number :
Provider Business Practice Location Address
First Line : 1229 S 2ND ST
Second Line :
City : CLEARFIELD
State : PA
Zip : 16830-3305
Country : US
Telephone Number : 814-765-0221
Fax Number : 814-765-3011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. COURTNEY L MIKESELL COTA” Practice Location

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