Healthcare Provider Details

I. General information

NPI: 1831123736
Provider Name (Legal Business Name): JENNIFER D GRUSHINSKI COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MEDICAL PARK DR
AIKEN SC
29801-5385
US

IV. Provider business mailing address

690 MEDICAL PARK DR
AIKEN SC
29801
US

V. Phone/Fax

Practice location:
  • Phone: 803-643-1701
  • Fax: 803-643-1702
Mailing address:
  • Phone: 864-923-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2346
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: