Healthcare Provider Details

I. General information

NPI: 1477697803
Provider Name (Legal Business Name): ROBERT WHITTINGHAM ANDERSON COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 SAVAGE RD SUITE 400C
CHARLESTON SC
29407-4704
US

IV. Provider business mailing address

PO BOX 1582
DILLON SC
29536-1582
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-2700
  • Fax:
Mailing address:
  • Phone: 843-453-7524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2382
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: