Healthcare Provider Details

I. General information

NPI: 1225435688
Provider Name (Legal Business Name): MEGAN HAWKINS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N LOGAN AVE
DANVILLE IL
61832-3715
US

IV. Provider business mailing address

2 CARTER DR
OAKWOOD IL
61858-6165
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-3106
  • Fax:
Mailing address:
  • Phone: 217-271-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.004087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: