MEDICARE: MRS. CATHY A. WHITE COTA/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	171W00000X	Contractor	#OA1348	ME

General Provider Information

NPI Number	:	1457638942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHY A. WHITE COTA/L

Provider Business Mailing Address
First Line	:	311 COTTRELL RD
Second Line	:
City	:	DIXMONT
State	:	ME
Zip	:	04932-3242
Country	:	US
Telephone Number	:	207-234-4693
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 COTTRELL RD
Second Line	:
City	:	DIXMONT
State	:	ME
Zip	:	04932-3242
Country	:	US
Telephone Number	:	207-234-4693
Fax Number	:

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

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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