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General NPI Number Information
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NPI Number | 1598215055
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Entity Type | Individual
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Provider Name | JACLENE MATHIS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/09/2016
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 3025 ASHLEY PHOSPHATE RD STE C1B
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-8447
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Country | US
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Telephone | 843-568-2932
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Fax |
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Provider Business Mailing Address
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Address Line | 524 PLEASANT SIDE DR
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City | MONCKS CORNER
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State | SC
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Zip | 29461-7387
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Country | US
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Telephone | 843-568-2932
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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 | 3060
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License Number State | SC
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