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General NPI Number Information
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NPI Number | 1912299538
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Entity Type | Individual
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Provider Name | KIMBERLY MIRO COTA
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Gender | Female
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Dates
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Enumeration Date | 05/15/2011
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Last Update Date | 05/15/2011
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Provider Practice Location Address
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Address Line | 850 E BUTLER RD
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City | GREENVILLE
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State | SC
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Zip | 29607-5842
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Country | US
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Telephone | 864-675-6421
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Fax | 864-675-9122
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Provider Business Mailing Address
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Address Line | 2 BELLSPRING CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7063
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Country | US
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Telephone | 864-757-1598
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 1326A
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License Number State | SC
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