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General NPI Number Information
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NPI Number | 1619291960
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Entity Type | Individual
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Provider Name | CARMELLETTA BRADLEY COTA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 3062 E 91ST ST
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City | CHICAGO
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State | IL
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Zip | 60617-4401
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Country | US
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Telephone | 773-437-4740
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Fax | 773-530-0809
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Provider Business Mailing Address
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Address Line | 3062 E 91ST ST
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City | CHICAGO
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State | IL
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Zip | 60617-4401
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Country | US
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Telephone | 773-437-4740
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Fax | 773-530-0809
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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 | 32001497A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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