Provider Demographics
NPI:1811875560
Name:ANDERSON, TABBITHA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:TABBITHA
Middle Name:LYNN
Last Name:ANDERSON
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 1:575 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2801
Mailing Address - Country:US
Mailing Address - Phone:708-890-5631
Mailing Address - Fax:
Practice Address - Street 1:120 E OGDEN AVE STE 17
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3542
Practice Address - Country:US
Practice Address - Phone:630-320-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057006266224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant