Healthcare Provider Details

I. General information

NPI: 1295645356
Provider Name (Legal Business Name): STEPHANIE KAY MCGINLEY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 E MARYLAND ST
DECATUR IL
62521-9705
US

IV. Provider business mailing address

2896 GROVE CT
DECATUR IL
62521-5668
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-1264
  • Fax:
Mailing address:
  • Phone: 217-519-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.002458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: