Most Relevant Information
Provider Data
| NPI Number: | 1003464413 |
| Provider Name: | ALLIAH M IQBAL COTA |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 057.005234 |
Most Important Dates
| Enumeration Date: | 08/28/2019 |
| Last Updated: | 08/28/2019 |
Provider Practice Location
2390 S LOST BRIDGE RD
DECATUR
IL
625214653
Practice Location Phone/Fax
| Phone: | 2176200687 |
| Fax: |
Provider Mailing Location
2390 S LOST BRIDGE RD
DECATUR
IL
625214653
Provider Mailing Phone/Fax
| Phone: | 2176200687 |
| Fax: |