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NPI Code Detail

MEDICARE: LEAH ROSE FORSYTHE COTA

MEDICARE: LEAH ROSE FORSYTHE 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 Assistant4185MA
2225X00000XOccupational Therapist056.015218IL

General Provider Information

NPI Number : 1578092458
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH ROSE FORSYTHE COTA
Provider Business Mailing Address
First Line : 5359 W WILSON AVE APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60630-3881
Country : US
Telephone Number : 864-546-1277
Fax Number :
Provider Business Practice Location Address
First Line : 2319 N ORCHARD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-0008
Country : US
Telephone Number : 773-755-7791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2017
Last Update Date : 11/18/2022

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Directions to “ LEAH ROSE FORSYTHE COTA” Practice Location

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