Provider Demographics
NPI:1639277171
Name:WALDROP, DONNA SMITH (COTA L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SMITH
Last Name:WALDROP
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 1:222 NATION RD
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:SC
Mailing Address - Zip Code:29653-9387
Mailing Address - Country:US
Mailing Address - Phone:864-374-3956
Mailing Address - Fax:
Practice Address - Street 1:437 E CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2244
Practice Address - Country:US
Practice Address - Phone:864-223-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2391224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant