Provider Demographics
NPI:1497887665
Name:HUDSON, CARMEN ELANE (COTA L)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:ELANE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:ELANE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA L
Mailing Address - Street 1:113 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-1900
Mailing Address - Country:US
Mailing Address - Phone:864-992-8805
Mailing Address - Fax:
Practice Address - Street 1:38 LAKES AT LITCHFIELD DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-5768
Practice Address - Country:US
Practice Address - Phone:843-237-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2443224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant