Provider Demographics
NPI:1801519103
Name:ZAVALA, JEANNETE (COTA)
Entity type:Individual
Prefix:
First Name:JEANNETE
Middle Name:
Last Name:ZAVALA
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 1:498 E ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:ONARGA
Mailing Address - State:IL
Mailing Address - Zip Code:60955-1336
Mailing Address - Country:US
Mailing Address - Phone:815-644-1689
Mailing Address - Fax:
Practice Address - Street 1:100 FITNESS DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9584
Practice Address - Country:US
Practice Address - Phone:815-928-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005708224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant