MEDICARE: KELSEY ANNE PROCTOR COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA.5883	SC

General Provider Information

NPI Number	:	1073468161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY ANNE PROCTOR COTA/L

Provider Business Mailing Address
First Line	:	157 CATO RD
Second Line	:
City	:	WARRENVILLE
State	:	SC
Zip	:	29851-2715
Country	:	US
Telephone Number	:	803-991-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 E MARTINTOWN RD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3425
Country	:	US
Telephone Number	:	803-993-9959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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