Provider Demographics
NPI:1033080510
Name:ROLLINS, CAROLANDA TIFFANY (COTA)
Entity type:Individual
Prefix:
First Name:CAROLANDA
Middle Name:TIFFANY
Last Name:ROLLINS
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 1:400 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1869
Mailing Address - Country:US
Mailing Address - Phone:708-743-0411
Mailing Address - Fax:
Practice Address - Street 1:400 DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1869
Practice Address - Country:US
Practice Address - Phone:708-743-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057003406224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant