MEDICARE: MRS. KATHLEEN MARIE BRESLINFOULKROD COTA/L, B.S.

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	224Z00000X	Occupational Therapy Assistant	OP001711L	PA

General Provider Information

NPI Number	:	1346683281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE BRESLINFOULKROD COTA/L, B.S.

Provider Business Mailing Address
First Line	:	4300 TACONY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4134
Country	:	US
Telephone Number	:	215-743-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 TACONY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4134
Country	:	US
Telephone Number	:	215-743-3100
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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