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General NPI Number Information
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NPI Number | 1710554142
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Entity Type | Individual
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Provider Name | CHARLENE DEJOSEPH COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 421 BARONY ST STE 3
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City | MONCKS CORNER
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State | SC
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Zip | 29461-3145
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Country | US
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Telephone | 843-790-4093
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51025
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City | SUMMERVILLE
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State | SC
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Zip | 29485-1025
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Country | US
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Telephone |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4881
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License Number State | SC
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