Healthcare Provider Details

I. General information

NPI: 1063602316
Provider Name (Legal Business Name): MICHAEL ALBERT SLAFKA COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 INDIA HOOK RD
ROCK HILL SC
29732-2412
US

IV. Provider business mailing address

1716 QUARTZ RDG
FORT MILL SC
29708-7899
US

V. Phone/Fax

Practice location:
  • Phone: 803-326-3116
  • Fax:
Mailing address:
  • Phone: 412-527-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2711
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: