Provider Demographics
NPI:1154108900
Name:MUSE, TREVOR STEVEN (COTA/L)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:STEVEN
Last Name:MUSE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:TREVOR
Other - Middle Name:STEVEN
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:724 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-8510
Mailing Address - Country:US
Mailing Address - Phone:803-528-1891
Mailing Address - Fax:
Practice Address - Street 1:1 STILL HOPES DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7164
Practice Address - Country:US
Practice Address - Phone:803-796-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4904224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant