Healthcare Provider Details

I. General information

NPI: 1801315031
Provider Name (Legal Business Name): HANNAH LUNSFORD HOFFMAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH GRACE LUNSFORD COTA/L

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E CHEVES ST
FLORENCE SC
29506-2617
US

IV. Provider business mailing address

555 E CHEVES ST
FLORENCE SC
29506-2617
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-2000
  • Fax:
Mailing address:
  • Phone: 843-777-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3302
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: