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NPI Code Detail

MEDICARE: JESSICA ANN MICHALEC COTA/L

MEDICARE: JESSICA ANN MICHALEC 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 Assistant

General Provider Information

NPI Number : 1437892585
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ANN MICHALEC COTA/L
Provider Business Mailing Address
First Line : 3616 S 59TH AVE APT 2
Second Line :
City : CICERO
State : IL
Zip : 60804-4263
Country : US
Telephone Number : 872-223-1619
Fax Number :
Provider Business Practice Location Address
First Line : 735 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-2337
Country : US
Telephone Number : 773-348-4055
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2022
Last Update Date : 04/17/2022

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