Healthcare Provider Details

I. General information

NPI: 1275002867
Provider Name (Legal Business Name): JENNIFER L ROCK COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 COMPASS RD
GLENVIEW IL
60026-8001
US

IV. Provider business mailing address

11215 BLOOM RD
GARRETTSVILLE OH
44231-9774
US

V. Phone/Fax

Practice location:
  • Phone: 877-441-0734
  • Fax: 847-441-0734
Mailing address:
  • Phone: 412-706-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA007160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: