Healthcare Provider Details

I. General information

NPI: 1275758856
Provider Name (Legal Business Name): THERESA ROBINSON KALISH COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S PAULINA ST SUITE 400
CHICAGO IL
60612-3808
US

IV. Provider business mailing address

1340 MANDEL AVE
WESTCHESTER IL
60154-3433
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-7010
  • Fax:
Mailing address:
  • Phone: 708-836-1036
  • Fax:

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: