Provider Demographics
NPI:1972636249
Name:FOWLER, LINDA ELAINE (COTAL)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELAINE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 OLD POST RD
Mailing Address - Street 2:1307 OLD POST RD.
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-3433
Mailing Address - Country:US
Mailing Address - Phone:864-902-0573
Mailing Address - Fax:864-902-0719
Practice Address - Street 1:223 TIFFANY PARK
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1266
Practice Address - Country:US
Practice Address - Phone:864-902-0573
Practice Address - Fax:864-902-0719
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2411224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant