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NPI Code Detail

MEDICARE: TRAVIS HEATON COTA/L

MEDICARE: TRAVIS HEATON 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
1224Z00000XOccupational Therapy Assistant3187SC

General Provider Information

NPI Number : 1730510025
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS HEATON COTA/L
Provider Business Mailing Address
First Line : 204 SHADY PINES CT
Second Line :
City : FOUNTAIN INN
State : SC
Zip : 29644-9785
Country : US
Telephone Number : 864-399-2674
Fax Number :
Provider Business Practice Location Address
First Line : 204 SHADY PINES CT
Second Line :
City : FOUNTAIN INN
State : SC
Zip : 29644-9785
Country : US
Telephone Number : 864-399-2674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2013
Last Update Date : 12/11/2013

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Directions to “ TRAVIS HEATON COTA/L” Practice Location

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