Healthcare Provider Details

I. General information

NPI: 1679703763
Provider Name (Legal Business Name): CAPRICE Y. ALEXANDER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 THOMPSON ST
GAFFNEY SC
29340-3620
US

IV. Provider business mailing address

205 S CAROLINA AVE
SPARTANBURG SC
29306-5025
US

V. Phone/Fax

Practice location:
  • Phone: 978-474-7500
  • Fax:
Mailing address:
  • Phone: 864-582-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2799
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: