MEDICARE: ERIN D HOLDEN COTA

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	057.002535	IL

General Provider Information

NPI Number	:	1093919102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN D HOLDEN COTA

Provider Business Mailing Address
First Line	:	4343 N CLARENDON AVE
Second Line	:	UNIT 1917
City	:	CHICAGO
State	:	IL
Zip	:	60613-2698
Country	:	US
Telephone Number	:	773-935-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1503
Country	:	US
Telephone Number	:	773-348-3980
Fax Number	:	773-348-3980

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	03/09/2010

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