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NPI Code Detail

MEDICARE: ROSALYN T TOOMBS COTA/L

MEDICARE: ROSALYN T TOOMBS 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 Assistant057001053IL

General Provider Information

NPI Number : 1538624077
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSALYN T TOOMBS COTA/L
Provider Business Mailing Address
First Line : 2224 W WESTPORT RD
Second Line :
City : PEORIA
State : IL
Zip : 61615-4243
Country : US
Telephone Number : 309-453-3886
Fax Number :
Provider Business Practice Location Address
First Line : 900 CENTENNIAL DR
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-4928
Country : US
Telephone Number : 309-699-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2019
Last Update Date : 02/08/2019

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