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General NPI Number Information
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NPI Number | 1972061901
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Entity Type | Individual
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Provider Name | CAROL JEAN ZILZ COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 4825 EVERGREEN CT
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City | DECATUR
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State | IL
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Zip | 62521-8774
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Country | US
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Telephone | 217-864-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 10113 JORDAN RD
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City | ARGENTA
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State | IL
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Zip | 62501-8115
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Country | US
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Telephone | 217-454-4605
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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 | 057.000390
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License Number State | IL
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