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General NPI Number Information
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NPI Number | 1780357194
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Entity Type | Individual
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Provider Name | JOANNE I LANGE COTA
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Gender | Female
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 1111 W NORTH 12 ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565
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Country | US
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Telephone | 217-246-0346
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Fax |
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Provider Business Mailing Address
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Address Line | 232 N CALHOUN ST
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City | SULLIVAN
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State | IL
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Zip | 61951-1608
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Country | US
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Telephone | 217-246-0346
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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 | 057.004337
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License Number State | IL
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