Healthcare Provider Details

I. General information

NPI: 1578601142
Provider Name (Legal Business Name): KAREN ANN DEVEREAUX COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 SUNSET BLVD
WEST COLUMBIA SC
29169-4718
US

IV. Provider business mailing address

101 SPRING VIEW CT
LEXINGTON SC
29072-4109
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-8024
  • Fax:
Mailing address:
  • Phone: 803-808-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1910
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: