Provider Demographics
NPI:1518639004
Name:VALENTINE, JOHN'TA LINDA (COTA/L)
Entity Type:Individual
Prefix:
First Name:JOHN'TA
Middle Name:LINDA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15405 PARK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1366
Mailing Address - Country:US
Mailing Address - Phone:708-501-8538
Mailing Address - Fax:
Practice Address - Street 1:15405 PARK LN
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1366
Practice Address - Country:US
Practice Address - Phone:708-501-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005495224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant