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General NPI Number Information
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NPI Number | 1407126477
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Entity Type | Individual
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Provider Name | NICOLE PERTEETE COTA
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Gender | Female
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 4437 S CICERO AVE
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City | CHICAGO
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State | IL
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Zip | 60632-4333
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Country | US
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Telephone | 773-955-1364
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Fax |
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Provider Business Mailing Address
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Address Line | 231 E 59TH ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60637-1314
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Country | US
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Telephone | 312-567-0676
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Fax | 773-955-1364
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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 | 057002275
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License Number State | IL
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