Healthcare Provider Details

I. General information

NPI: 1710807649
Provider Name (Legal Business Name): AMANDA KIMBERLY SCHWARZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRANT ST
EVANSTON IL
60201-1903
US

IV. Provider business mailing address

5954 N MAGNOLIA AVE APT 3S
CHICAGO IL
60660-4161
US

V. Phone/Fax

Practice location:
  • Phone: 847-492-2800
  • Fax:
Mailing address:
  • Phone: 312-480-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057016334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: