=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093596926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OTWITHZ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2023
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 602 E MAIN ST STE C4
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29072-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-881-4787
-----------------------------------------------------
Fax | 803-369-8739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 HUXLEY CT
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29072-8263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-361-8984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MISS ZADA K WOOTEN
-----------------------------------------------------
Credential | OTR/L, ASD-CS
-----------------------------------------------------
Telephone | 770-361-8984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------