Healthcare Provider Details

I. General information

NPI: 1144493545
Provider Name (Legal Business Name): MS. PATRICIA C COKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 RUTLEDGE AVE
CHARLESTON SC
29403-6850
US

IV. Provider business mailing address

PO BOX 292
FOLLY BEACH SC
29439-0292
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-7491
  • Fax: 843-792-3075
Mailing address:
  • Phone: 843-792-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2214
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: