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General NPI Number Information
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NPI Number | 1770058091
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Entity Type | Individual
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Provider Name | MONICA E. MISTHAL COTA/L, CDP, CDS
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Gender | Female
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Dates
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Enumeration Date | 10/13/2018
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Last Update Date | 10/13/2018
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Provider Practice Location Address
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Address Line | 714 N GRANT ST
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City | CLINTON
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State | IL
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Zip | 61727-1011
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Country | US
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Telephone | 217-671-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 714 N GRANT ST
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City | CLINTON
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State | IL
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Zip | 61727-1011
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Country | US
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Telephone | 217-671-2280
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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 | 057.003702
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License Number State | IL
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