MEDICARE: MRS. RHONDA LYNN PUTNAM 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	2963	SC

General Provider Information

NPI Number	:	1972886919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA LYNN PUTNAM COTA/L

Provider Business Mailing Address
First Line	:	706 PATRIOT LN
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-5282
Country	:	US
Telephone Number	:	570-250-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 SULPHUR SPRINGS RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1621
Country	:	US
Telephone Number	:	864-246-2721
Fax Number	:

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

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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