MEDICARE: MISS LAURA L DRAKE COTA

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	46TA09043100	NJ

General Provider Information

NPI Number	:	1720101603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAURA L DRAKE COTA

Provider Business Mailing Address
First Line	:	123 HAINES NECK RD
Second Line	:
City	:	SALEM
State	:	NJ
Zip	:	08079-4516
Country	:	US
Telephone Number	:	856-299-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 HAINES NECK RD
Second Line	:
City	:	SALEM
State	:	NJ
Zip	:	08079-4516
Country	:	US
Telephone Number	:	856-299-7779
Fax Number	:

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

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	07/08/2007

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