Provider Demographics
NPI:1013795970
Name:VELASCO, MARJORIE JANE COTONER
Entity Type:Individual
Prefix:
First Name:MARJORIE JANE
Middle Name:COTONER
Last Name:VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4665
Mailing Address - Country:US
Mailing Address - Phone:323-533-6236
Mailing Address - Fax:
Practice Address - Street 1:149 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-4665
Practice Address - Country:US
Practice Address - Phone:323-533-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach