MEDICARE: MS. FELICIA PAMELA LEIBENSPERGER 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	310400000X	Assisted Living Facility	OP007964	PA

General Provider Information

NPI Number	:	1750751012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FELICIA PAMELA LEIBENSPERGER COTA/L

Provider Business Mailing Address
First Line	:	5609 SNYDERS CHURCH ROAD
Second Line	:
City	:	NORTHAMPTON
State	:	PA
Zip	:	18067
Country	:	US
Telephone Number	:	610-216-4023
Fax Number	:

Provider Business Practice Location Address
First Line	:	10600 YORK RD
Second Line	:
City	:	COCKEYSVILLE
State	:	MD
Zip	:	21030-2351
Country	:	US
Telephone Number	:	410-667-7200
Fax Number	:

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

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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