Provider Demographics
NPI:1598468191
Name:TURNER, TERRA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:MARIE
Last Name:TURNER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 HARTS PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62638-5029
Mailing Address - Country:US
Mailing Address - Phone:217-371-0667
Mailing Address - Fax:
Practice Address - Street 1:101 VILLA PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-9666
Practice Address - Country:US
Practice Address - Phone:217-744-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005945224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant