Provider Demographics
NPI:1194957282
Name:HUGHEY, SAMANTHA (COTA)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:HUGHEY
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 1:112 COTSWOLD AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9624
Mailing Address - Country:US
Mailing Address - Phone:864-346-4189
Mailing Address - Fax:
Practice Address - Street 1:100 SUMMIT HILLS DR
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1532
Practice Address - Country:US
Practice Address - Phone:864-342-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2433224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant