MEDICARE: RHONDA GAYLE WEICHSEL COTAL

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	2461	SC

General Provider Information

NPI Number	:	1467677823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA GAYLE WEICHSEL COTAL

Provider Business Mailing Address
First Line	:	925 MCIVER ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4959
Country	:	US
Telephone Number	:	843-856-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5830
Country	:	US
Telephone Number	:	843-763-4055
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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