Healthcare Provider Details

I. General information

NPI: 1205005733
Provider Name (Legal Business Name): JANET E. GONZALES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E SUPERIOR ST
CHICAGO IL
60611-2654
US

IV. Provider business mailing address

434 ROTHBURY DR
BOLINGBROOK IL
60440-2253
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-1228
  • Fax: 312-238-1229
Mailing address:
  • Phone: 312-238-1228
  • Fax: 312-238-1229

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: