MEDICARE: BERTHA MAKOTHA

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1043653132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTHA MAKOTHA

Provider Business Mailing Address
First Line	:	1140 N CAPITOL ST NW APT 406
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7568
Country	:	US
Telephone Number	:	240-603-5455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 N CAPITOL ST NW APT 406
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7568
Country	:	US
Telephone Number	:	240-603-5455
Fax Number	:

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

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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Directions to “ BERTHA MAKOTHA ” Practice Location

Language	Start Address	Practice Location

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