Provider Demographics
NPI:1306204920
Name:CARTER, AKITA NICOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:AKITA
Middle Name:NICOLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HEATHER GLENN LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7877
Mailing Address - Country:US
Mailing Address - Phone:843-540-0502
Mailing Address - Fax:
Practice Address - Street 1:39 HEATHER GLENN LN
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7877
Practice Address - Country:US
Practice Address - Phone:843-540-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2956224Z00000X
VA0131001103224Z00000X
AZ5711224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant