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NPI Code Detail

MEDICARE: JEANNINE DANIELS COTA/L

MEDICARE: JEANNINE DANIELS 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 Assistant057.003369IL

General Provider Information

NPI Number : 1689141921
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNINE DANIELS COTA/L
Provider Business Mailing Address
First Line : 3800 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3606
Country : US
Telephone Number : 773-596-5166
Fax Number :
Provider Business Practice Location Address
First Line : 3800 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3606
Country : US
Telephone Number : 773-596-5166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2018
Last Update Date : 10/24/2018

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