Healthcare Provider Details

I. General information

NPI: 1891602140
Provider Name (Legal Business Name): MANDY LYN TURNER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 TRAVELERS BLVD
SUMMERVILLE SC
29485-8213
US

IV. Provider business mailing address

5213 CARLISLE CT
SUMMERVILLE SC
29485-8793
US

V. Phone/Fax

Practice location:
  • Phone: 843-568-6604
  • Fax:
Mailing address:
  • Phone: 843-568-6604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3377
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: