MEDICARE: MRS. KENDRA Q BIGELOW 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	2010032131	MO
2	224Z00000X	Occupational Therapy Assistant	057.003372	IL

General Provider Information

NPI Number	:	1073818779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDRA Q BIGELOW COTA/L

Provider Business Mailing Address
First Line	:	6333 S CAMPBELL AVE
Second Line	:	2ND FLR
City	:	CHICAGO
State	:	IL
Zip	:	60629-1217
Country	:	US
Telephone Number	:	636-439-9168
Fax Number	:

Provider Business Practice Location Address
First Line	:	6333 S CAMPBELL AVE
Second Line	:	2ND FLR
City	:	CHICAGO
State	:	IL
Zip	:	60629-1217
Country	:	US
Telephone Number	:	636-439-9168
Fax Number	:

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

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	06/25/2015

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