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General NPI Number Information
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NPI Number | 1053804880
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Entity Type | Individual
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Provider Name | LORINDA GOLAB COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 4812 S AVERS AVE
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City | CHICAGO
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State | IL
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Zip | 60632-3627
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Country | US
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Telephone | 773-317-1315
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 JENNA DR UNIT A
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-3425
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Country | US
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Telephone | 773-317-1315
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-17-44844
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.005589
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License Number State | IL
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