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General NPI Number Information
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NPI Number | 1356605414
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Entity Type | Individual
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Provider Name | JENNIFER MICHELLE COSLET COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 1011 N MAIN ST
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City | PARIS
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State | IL
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Zip | 61944-1145
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Country | US
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Telephone | 217-465-5376
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Fax |
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Provider Business Mailing Address
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Address Line | 506 W GREEN ST
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City | NEWMAN
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State | IL
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Zip | 61942-9407
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Country | US
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Telephone | 217-714-9628
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057003135
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License Number State | IL
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