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NPI Code Detail

MEDICARE: MARY B. STECKLINE COTA

MEDICARE: MARY B. STECKLINE 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
1313M00000XNursing Facility/Intermediate Care Facility0000000737TN

General Provider Information

NPI Number : 1053538934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY B. STECKLINE COTA
Provider Business Mailing Address
First Line : 4123 GOLF VIEW CV
Second Line :
City : BARTLETT
State : TN
Zip : 38135-5195
Country : US
Telephone Number : 901-382-1640
Fax Number :
Provider Business Practice Location Address
First Line : 2805 CHARLES BRYAN RD
Second Line :
City : BARTLETT
State : TN
Zip : 38134-4756
Country : US
Telephone Number : 901-388-4775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 07/08/2007

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