Healthcare Provider Details

I. General information

NPI: 1093596926
Provider Name (Legal Business Name): OTWITHZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E MAIN ST STE C4
LEXINGTON SC
29072-3729
US

IV. Provider business mailing address

128 HUXLEY CT
LEXINGTON SC
29072-8263
US

V. Phone/Fax

Practice location:
  • Phone: 803-881-4787
  • Fax: 803-369-8739
Mailing address:
  • Phone: 770-361-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS ZADA K WOOTEN
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L, ASD-CS
Phone: 770-361-8984