Provider Demographics
NPI:1295939445
Name:LAND, PATRICIA S (COTA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:S
Last Name:LAND
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 1:4871 RADNOR DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-3126
Mailing Address - Country:US
Mailing Address - Phone:815-874-9142
Mailing Address - Fax:
Practice Address - Street 1:650 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-6921
Practice Address - Country:US
Practice Address - Phone:815-965-6745
Practice Address - Fax:815-968-9563
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant