Healthcare Provider Details

I. General information

NPI: 1104900331
Provider Name (Legal Business Name): CONNIE MILLER SANDIFER COTA/L, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2993 SUNSET BLVD
WEST COLUMBIA SC
29169-3421
US

IV. Provider business mailing address

1057 HILTON POINT RD
CHAPIN SC
29036-9792
US

V. Phone/Fax

Practice location:
  • Phone: 803-939-0026
  • Fax:
Mailing address:
  • Phone: 803-345-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1931
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS . 3908
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: