Provider Demographics
NPI:1639374739
Name:COATES, JENNIFER-ANN SALES (OTD)
Entity Type:Individual
Prefix:
First Name:JENNIFER-ANN
Middle Name:SALES
Last Name:COATES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:JENNIFER-ANN
Other - Middle Name:CASTANEDA
Other - Last Name:SALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:1010 EXECUTIVE DR STE 250
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6137
Practice Address - Country:US
Practice Address - Phone:630-655-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist