Provider Demographics
NPI:1366894362
Name:CORTES, SOPHIA (COTA/L)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 ROHLWING RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1397
Mailing Address - Country:US
Mailing Address - Phone:224-248-9449
Mailing Address - Fax:
Practice Address - Street 1:6606 N HARLEM AVE APT 2W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3902
Practice Address - Country:US
Practice Address - Phone:520-233-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6569224Z00000X
IL057006084224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant