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General NPI Number Information
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NPI Number | 1801104286
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Entity Type | Individual
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Provider Name | CYNTHIA ANN LOHR COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/19/2010
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Last Update Date | 01/20/2014
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Provider Practice Location Address
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Address Line | 1507 7TH ST
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City | LINCOLN
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State | IL
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Zip | 62656-2216
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Country | US
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Telephone | 217-732-4826
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Fax |
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Provider Business Mailing Address
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Address Line | 203 PACKARD ST
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4764
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Country | US
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Telephone | 217-369-9503
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 057.002833
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License Number State | IL
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