Provider Demographics
NPI:1194247528
Name:PRINCE, TAWNIA LEE (COTA)
Entity type:Individual
Prefix:
First Name:TAWNIA
Middle Name:LEE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-3510
Mailing Address - Country:US
Mailing Address - Phone:828-817-4245
Mailing Address - Fax:
Practice Address - Street 1:110 SUMMIT KNOLL DRIVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307
Practice Address - Country:US
Practice Address - Phone:864-591-2222
Practice Address - Fax:864-541-0069
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10946224Z00000X
CO0000910224Z00000X
SC3705224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant