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NPI Code Detail

MEDICARE: MRS. COLLEEN ANN RODGERS COTA

MEDICARE: MRS. COLLEEN ANN RODGERS 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
1224Z00000XOccupational Therapy Assistant057.004031IL

General Provider Information

NPI Number : 1518367911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLEEN ANN RODGERS COTA
Provider Business Mailing Address
First Line : 5202 HEATHER LN
Second Line :
City : JOHNSBURG
State : IL
Zip : 60051-5215
Country : US
Telephone Number : 815-245-7986
Fax Number :
Provider Business Practice Location Address
First Line : 390 E CONGRESS PKWY
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-6202
Country : US
Telephone Number : 815-477-4788
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2014
Last Update Date : 09/04/2014

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