Healthcare Provider Details

I. General information

NPI: 1942563010
Provider Name (Legal Business Name): WENDY SEXAUER C.O.T.A./L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E BUTLER RD
GREENVILLE SC
29607-5842
US

IV. Provider business mailing address

850 E BUTLER RD
GREENVILLE SC
29607-5842
US

V. Phone/Fax

Practice location:
  • Phone: 864-675-6421
  • Fax: 864-675-9122
Mailing address:
  • Phone: 864-675-6421
  • Fax: 864-675-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2527
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6814
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: