Healthcare Provider Details

I. General information

NPI: 1508779877
Provider Name (Legal Business Name): JESSICA RAMOS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17716 OAK PARK AVE
TINLEY PARK IL
60477-3936
US

IV. Provider business mailing address

3606 FLOWERMEADOW CT
JOLIET IL
60431-8749
US

V. Phone/Fax

Practice location:
  • Phone: 708-269-7302
  • Fax:
Mailing address:
  • Phone: 708-269-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.005652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: