Provider Demographics
NPI:1831431477
Name:MCCARTY, ANGELA MARIE (COTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MCCARTY
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 1:2649 S HOMER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:IL
Mailing Address - Zip Code:61849-9756
Mailing Address - Country:US
Mailing Address - Phone:217-840-3812
Mailing Address - Fax:
Practice Address - Street 1:2649 S HOMER LAKE RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:IL
Practice Address - Zip Code:61849-9756
Practice Address - Country:US
Practice Address - Phone:217-840-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002743224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant