Healthcare Provider Details

I. General information

NPI: 1386167823
Provider Name (Legal Business Name): ALLISON RENEE GEISSMAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON R SANFORD COTA/L

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W LANE RD
MACHESNEY PARK IL
61115-1625
US

IV. Provider business mailing address

1205 W LANE RD
MACHESNEY PARK IL
61115-1625
US

V. Phone/Fax

Practice location:
  • Phone: 779-218-8739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.005764
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5857-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: