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NPI Code Detail

MEDICARE: ERIC HOWARD COTA/L

MEDICARE: ERIC HOWARD 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 Assistant057.003328IL

General Provider Information

NPI Number : 1518259159
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC HOWARD COTA/L
Provider Business Mailing Address
First Line : 5254 N ASHLAND AVE APT 2N
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2589
Country : US
Telephone Number : 773-895-3742
Fax Number :
Provider Business Practice Location Address
First Line : 2649 E 75TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3835
Country : US
Telephone Number : 773-356-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2011
Last Update Date : 05/13/2011

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