Provider Demographics
NPI:1437739760
Name:RADFORD, AUSTIN COLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:COLE
Last Name:RADFORD
Suffix:
Gender:M
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 1:7980 MOUNT OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1366
Mailing Address - Country:US
Mailing Address - Phone:704-960-5722
Mailing Address - Fax:
Practice Address - Street 1:3700 TAYLOR GLEN LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3400
Practice Address - Country:US
Practice Address - Phone:704-788-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13105224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant