MEDICARE: KRISTIN ROMERO COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	057.002922	IL

General Provider Information

NPI Number	:	1003748534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ROMERO COTA/L

Provider Business Mailing Address
First Line	:	849 LEWIS AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	849 LEWIS AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2323
Country	:	US
Telephone Number	:	618-610-9419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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