Healthcare Provider Details

I. General information

NPI: 1184822835
Provider Name (Legal Business Name): CATHY A CHADWICK COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CATHY A IVY

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 PARKLANE RD
COLUMBIA SC
29223-6122
US

IV. Provider business mailing address

5835 JAIME DR
GROVETOWN GA
30813-5007
US

V. Phone/Fax

Practice location:
  • Phone: 803-741-9090
  • Fax: 803-741-1914
Mailing address:
  • Phone: 706-556-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2708
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: