MEDICARE: MS. RITA KAY COKER LCSW

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	104100000X	Social Worker	LMSW 40744	TX

General Provider Information

NPI Number	:	1275567737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA KAY COKER LCSW

Provider Business Mailing Address
First Line	:	3318 STURGIS LN
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-1749
Country	:	US
Telephone Number	:	254-297-3547
Fax Number	:	254-297-3396

Provider Business Practice Location Address
First Line	:	4800 MEMORIAL DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76711-1329
Country	:	US
Telephone Number	:	254-297-3547
Fax Number	:	254-297-3396

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/16/2008

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