MEDICARE: NANCY JANE GIROLAMO 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	057002737	IL

General Provider Information

NPI Number	:	1336396472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JANE GIROLAMO COTA

Provider Business Mailing Address
First Line	:	3154 JOHNSBURY LN
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-6828
Country	:	US
Telephone Number	:	630-236-0742
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 75TH ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7925
Country	:	US
Telephone Number	:	630-236-7000
Fax Number	:

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

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	08/20/2008

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