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NPI Code Detail

MEDICARE: MS. SHANNON GEISELL ISADORE COTA/L

MEDICARE: MS. SHANNON GEISELL ISADORE 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
1224Z00000XOccupational Therapy Assistant057002738IL

General Provider Information

NPI Number : 1285883579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANNON GEISELL ISADORE COTA/L
Provider Business Mailing Address
First Line : 1421 W SMITH ST
Second Line :
City : PEORIA
State : IL
Zip : 61605-1948
Country : US
Telephone Number : 309-472-4575
Fax Number :
Provider Business Practice Location Address
First Line : 2545 24TH ST
Second Line :
City : ROCK ISLAND
State : IL
Zip : 61201-5305
Country : US
Telephone Number : 309-786-2527
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2008
Last Update Date : 08/12/2010

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