Provider Demographics
NPI:1457905770
Name:WEST, LAURA FAITH (BS, COTA/L)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:FAITH
Last Name:WEST
Suffix:
Gender:F
Credentials:BS, COTA/L
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:FAITH
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, COTA/L
Mailing Address - Street 1:9225 UNIVERSITY BLVD STE E2C
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9149
Mailing Address - Country:US
Mailing Address - Phone:843-569-4546
Mailing Address - Fax:843-569-4535
Practice Address - Street 1:9225 UNIVERSITY BLVD STE E2C
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9149
Practice Address - Country:US
Practice Address - Phone:843-569-4546
Practice Address - Fax:843-569-4535
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3222224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3222OtherBOARD OF OCCUPATIONAL THERAPY EXAMINERS
SC312288OtherNBCOT