Healthcare Provider Details

I. General information

NPI: 1821560988
Provider Name (Legal Business Name): TORIE PLOCH COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 27TH ST
PERU IL
61354-1391
US

IV. Provider business mailing address

1627 27TH ST
PERU IL
61354-1391
US

V. Phone/Fax

Practice location:
  • Phone: 815-481-6893
  • Fax:
Mailing address:
  • Phone: 815-481-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224ZR0403X
TaxonomyDriving and Community Mobility Occupational Therapy Assistant
License Number7470
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: