Healthcare Provider Details

I. General information

NPI: 1487969382
Provider Name (Legal Business Name): KIM S ZOSS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FRONTAGE RD SUITE 2415
NORTHFIELD IL
60093-1202
US

IV. Provider business mailing address

550 FRONTAGE RD
NORTHFIELD IL
60093-1202
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.003261
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: