Healthcare Provider Details

I. General information

NPI: 1467317875
Provider Name (Legal Business Name): KESHIA LATONYA MOORE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MEMORIAL MEDICAL DR
GREENVILLE SC
29605-4407
US

IV. Provider business mailing address

4 SADDLE BOW CT
TAYLORS SC
29687-4089
US

V. Phone/Fax

Practice location:
  • Phone: 864-241-6222
  • Fax:
Mailing address:
  • Phone: 864-395-0624
  • Fax: 864-395-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3308
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: