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General NPI Number Information
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NPI Number | 1558633479
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Entity Type | Individual
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Provider Name | MOLLY UTZIG COTA
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Gender | Female
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 4401 N MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61103-1277
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Country | US
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Telephone | 779-771-6866
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Fax |
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Provider Business Mailing Address
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Address Line | 2206 MEADOWLARK DR
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City | JANESVILLE
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State | WI
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Zip | 53546-1176
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Country | US
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Telephone |
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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 | 057.003468
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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 | 4742-27
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License Number State | WI
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