MEDICARE: ELIZABETH COELI FALLON MSOTR/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	225X00000X	Occupational Therapist	OC008838	PA

General Provider Information

NPI Number	:	1144590282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH COELI FALLON MSOTR/L

Provider Business Mailing Address
First Line	:	865 N BAMBREY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1824
Country	:	US
Telephone Number	:	267-909-8757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 ARCH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1403
Country	:	US
Telephone Number	:	215-972-1700
Fax Number	:

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

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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