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General NPI Number Information
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NPI Number | 1992532956
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Entity Type | Individual
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Provider Name | LARISSA JUDY SZUREK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 3200 GRANT ST
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City | EVANSTON
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State | IL
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Zip | 60201-1903
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Country | US
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Telephone | 847-492-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 6424 N RICHMOND ST APT 3B
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City | CHICAGO
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State | IL
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Zip | 60645-4497
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Country | US
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Telephone | 817-925-0461
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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 | 057.006130
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License Number State | IL
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