Healthcare Provider Details

I. General information

NPI: 1801254040
Provider Name (Legal Business Name): CIARA TAYLOR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E CENTRAL RD
ARLINGTON HEIGHTS IL
60005-3244
US

IV. Provider business mailing address

300 S HARBOR BLVD
ANAHEIM CA
92805-3733
US

V. Phone/Fax

Practice location:
  • Phone: 847-956-4304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number057004432
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number057004432
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057004432
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: