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General NPI Number Information
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NPI Number | 1689138489
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Entity Type | Individual
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Provider Name | CIERRA SULLIVAN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 207 N MAPLE ST STE 12
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2338
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Country | US
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Telephone | 864-320-7244
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Fax |
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Provider Business Mailing Address
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Address Line | 2 PARADE DR
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City | GREENVILLE
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State | SC
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Zip | 29605-2751
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Country | US
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Telephone | 864-363-9782
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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 | 3706
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License Number State | SC
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