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General NPI Number Information
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NPI Number | 1407745532
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Entity Type | Individual
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Provider Name | JENNIFER LYNN HUDSON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 107 LOVETT DR
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City | GREENVILLE
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State | SC
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Zip | 29607-6510
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Country | US
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Telephone | 330-442-3624
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Fax |
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Provider Business Mailing Address
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Address Line | 313 S GREEN ST
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City | WILLIAMSTON
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State | SC
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Zip | 29697-1939
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Country | US
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Telephone | 330-442-3625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4983
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License Number State | SC
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