Provider Demographics
NPI:1750976338
Name:MAROTTA, ANN TERESE (COTA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:TERESE
Last Name:MAROTTA
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 1:616 MAJIC WAY
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3388
Mailing Address - Country:US
Mailing Address - Phone:815-382-5957
Mailing Address - Fax:
Practice Address - Street 1:525 HARVEST GATE
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4877
Practice Address - Country:US
Practice Address - Phone:847-957-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005412224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant