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General NPI Number Information
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NPI Number | 1003787359
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Entity Type | Individual
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Provider Name | MOLLIE ELIZABETH MURDOCK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 4450 N PROSPECT RD STE C5
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City | PEORIA HEIGHTS
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State | IL
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Zip | 61616-6578
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Country | US
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Telephone | 309-363-7594
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Fax | 309-966-3621
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Provider Business Mailing Address
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Address Line | 2223 106TH ST
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City | MONMOUTH
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State | IL
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Zip | 61462-9145
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Country | US
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Telephone | 309-363-7594
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Fax | 309-966-3621
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057006256
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License Number State | IL
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