Provider Demographics
NPI:1801119581
Name:LANGSTON, ROBERT BRUCE (COTA/L)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRUCE
Last Name:LANGSTON
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 1:102 ALMOND CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-6451
Mailing Address - Country:US
Mailing Address - Phone:864-247-6349
Mailing Address - Fax:
Practice Address - Street 1:914 BY-PASS 123
Practice Address - Street 2:CHILDRENS THERAPY CENTER
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29679-4757
Practice Address - Country:US
Practice Address - Phone:864-885-1981
Practice Address - Fax:864-885-1981
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1065224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant