Provider Demographics
NPI:1043995871
Name:CUNNINGHAM CATOE, ROQUAWNA
Entity Type:Individual
Prefix:
First Name:ROQUAWNA
Middle Name:
Last Name:CUNNINGHAM CATOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 HIGHWAY 160 W STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8010
Mailing Address - Country:US
Mailing Address - Phone:803-577-3671
Mailing Address - Fax:
Practice Address - Street 1:1749 GREAT FALLS RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-0234
Practice Address - Country:US
Practice Address - Phone:803-577-3671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSM8GLC55R335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier