Healthcare Provider Details

I. General information

NPI: 1346918992
Provider Name (Legal Business Name): JESSICA WAITE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 FURNACE HILLS PIKE
LITITZ PA
17543-7954
US

IV. Provider business mailing address

28100 TORCH PKWY STE 600
WARRENVILLE IL
60555-4030
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-2071
  • Fax:
Mailing address:
  • Phone: 630-413-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP009599
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: