MEDICARE: MS. JO ANN ELIZABETH MARSALA-GOETTEL PT

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	251300000X	Local Education Agency (LEA)	7122197	NY

General Provider Information

NPI Number	:	1295021848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JO ANN ELIZABETH MARSALA-GOETTEL PT

Provider Business Mailing Address
First Line	:	44 BRIDGE ST
Second Line	:
City	:	CLEVELAND
State	:	NY
Zip	:	13042-3189
Country	:	US
Telephone Number	:	315-378-5171
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 BRIDGE ST
Second Line	:
City	:	CLEVELAND
State	:	NY
Zip	:	13042-3189
Country	:	US
Telephone Number	:	315-378-5171
Fax Number	:

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	06/22/2011

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