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NPI Code Detail

MEDICARE: MRS. ELIZABETH AMELIA MCWHIRTER COTA/L

MEDICARE:  MRS. ELIZABETH AMELIA MCWHIRTER  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 Assistant057.004134IL

General Provider Information

NPI Number : 1811566565
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH AMELIA MCWHIRTER COTA/L
Provider Business Mailing Address
First Line : 2012 W DELRAY DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-3306
Country : US
Telephone Number : 309-657-1032
Fax Number :
Provider Business Practice Location Address
First Line : 5533 N GALENA RD
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-4447
Country : US
Telephone Number : 309-682-5428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2021
Last Update Date : 06/17/2021

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Directions to “ MRS. ELIZABETH AMELIA MCWHIRTER COTA/L” Practice Location

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