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General NPI Number Information
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NPI Number | 1720296700
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Entity Type | Individual
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Provider Name | LESLIE DARA HARVEY COTA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1941 SAVAGE RD STE 400C
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City | CHARLESTON
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State | SC
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Zip | 29407-4791
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Country | US
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Telephone | 866-571-2700
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Fax | 877-571-2124
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Provider Business Mailing Address
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Address Line | 80 BRIARVIEW CIR
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City | GREENVILLE
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State | SC
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Zip | 29615-2165
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Country | US
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Telephone | 864-561-3748
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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 | 2679
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License Number State | SC
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