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NPI Code Detail

MEDICARE: MICHELLE CARTER COTA/L

MEDICARE: MICHELLE CARTER 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 Assistant057004516IL

General Provider Information

NPI Number : 1659729242
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE CARTER COTA/L
Provider Business Mailing Address
First Line : 8201 S INDIANA AVE
Second Line : APT 3
City : CHICAGO
State : IL
Zip : 60619-4754
Country : US
Telephone Number : 773-398-3760
Fax Number :
Provider Business Practice Location Address
First Line : 5520 LINCOLN AVE
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3416
Country : US
Telephone Number : 224-707-0885
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2016
Last Update Date : 05/25/2016

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