Healthcare Provider Details

I. General information

NPI: 1750720207
Provider Name (Legal Business Name): LARENA E POWERS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W CHEVES ST
FLORENCE SC
29501-4449
US

IV. Provider business mailing address

424 N CHURCH ST
MANNING SC
29102-3310
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-1188
  • Fax:
Mailing address:
  • Phone: 803-435-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2193
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: