MEDICARE: MS. HOLLY MICHELLE EAGER 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
1	224Z00000X	Occupational Therapy Assistant	057.005183	IL

General Provider Information

NPI Number	:	1831732932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY MICHELLE EAGER COTA

Provider Business Mailing Address
First Line	:	6729 WHITE TAILED LN APT 2W
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-5094
Country	:	US
Telephone Number	:	816-260-2361
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320 159TH ST STE F
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2780
Country	:	US
Telephone Number	:	708-687-8768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	10/21/2019

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