Healthcare Provider Details

I. General information

NPI: 1043412331
Provider Name (Legal Business Name): OFELIA OLVERA-AUBURN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 N FRANCISCO AVE 1ST
CHICAGO IL
60618-2601
US

IV. Provider business mailing address

3244 N OZANAM AVE
CHICAGO IL
60634-3047
US

V. Phone/Fax

Practice location:
  • Phone: 773-263-6981
  • Fax: 773-293-6600
Mailing address:
  • Phone: 773-398-4647
  • Fax: 773-625-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: