Provider Demographics
NPI:1720895592
Name:COBB, MEGAN MCKENZIE (COTA-L)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MCKENZIE
Last Name:COBB
Suffix:
Gender:F
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 1:93 HERITAGE RIVERWOOD DR APT K
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-4558
Mailing Address - Country:US
Mailing Address - Phone:803-604-7871
Mailing Address - Fax:
Practice Address - Street 1:4226 HIGHWAY 378
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-9575
Practice Address - Country:US
Practice Address - Phone:803-604-7871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOTA.5704224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant