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General NPI Number Information
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NPI Number | 1366706962
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Entity Type | Individual
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Provider Name | LIANA MERIAN ALIS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 2625 W TOUHY AVE
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City | CHICAGO
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State | IL
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Zip | 60645-3109
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Country | US
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Telephone | 773-973-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 N NEWLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60707-4407
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Country | US
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Telephone | 773-991-7135
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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 | 057000269
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License Number State | IL
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