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NPI Code Detail

MEDICARE: BRITTANI A DALTON COTA/L

MEDICARE: BRITTANI A DALTON 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
1224Z00000XOccupational Therapy Assistant057006107IL

General Provider Information

NPI Number : 1275344350
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANI A DALTON COTA/L
Provider Business Mailing Address
First Line : 5277 E MARYLAND ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-9705
Country : US
Telephone Number : 217-408-5091
Fax Number :
Provider Business Practice Location Address
First Line : 5277 E MARYLAND ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-9705
Country : US
Telephone Number : 217-408-5091
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2025
Last Update Date : 01/16/2025

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Directions to “ BRITTANI A DALTON COTA/L” Practice Location

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