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General NPI Number Information
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NPI Number | 1437345741
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Entity Type | Individual
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Provider Name | DEWILDA MAY SPURLOCK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 1015 N TEXAS BLVD STE 20B #288
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City | WESLACO
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State | TX
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Zip | 78596-4529
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Country | US
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Telephone | 843-907-3380
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Fax |
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Provider Business Mailing Address
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Address Line | 2455 SALT MEADOW LN
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-6623
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Country | US
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Telephone | 843-907-3380
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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 | 2359
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License Number State | SC
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