MEDICARE: MISS LAPRECCA D COKES OTA

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	057.004957	IL

General Provider Information

NPI Number	:	1962966192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAPRECCA D COKES OTA

Provider Business Mailing Address
First Line	:	3405 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3819
Country	:	US
Telephone Number	:	312-791-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2818
Country	:	US
Telephone Number	:	773-752-6000
Fax Number	:

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

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	01/22/2019

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