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General NPI Number Information
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NPI Number | 1871299073
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Entity Type | Individual
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Provider Name | JESSICA BYERHOF COTA /L
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 2111 MIDLANDS CT
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City | SYCAMORE
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State | IL
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Zip | 60178-3125
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Country | US
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Telephone | 630-338-0594
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Fax |
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Provider Business Mailing Address
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Address Line | 1804 W FORESTVIEW DR
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City | SYCAMORE
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State | IL
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Zip | 60178-3426
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Country | US
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Telephone | 815-761-5956
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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 | 5697-27
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License Number State | WI
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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 | 057.005271
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License Number State | IL
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