Provider Demographics
NPI:1417509449
Name:COZART, VICTORIA LYNNE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNNE
Last Name:COZART
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 1:301 PALAMON DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5948
Mailing Address - Country:US
Mailing Address - Phone:706-830-5220
Mailing Address - Fax:
Practice Address - Street 1:3525 AUGUSTUS RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2701
Practice Address - Country:US
Practice Address - Phone:803-642-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant