Individual
KOTIONA MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
349 WESTMONT DR, DARBY, PA 19023-1023
(215) 578-0879
Mailing address
314 E 24TH ST APT B10, CHESTER, PA 19013-4809
(267) 206-0834
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
85-0604860
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85-0604860
NON MEDICAL
PA
Enumeration date
12/10/2020
Last updated
12/10/2020
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