Provider Demographics
NPI:1649861329
Name:WOOTEN, ZADA K (MOT)
Entity type:Individual
Prefix:
First Name:ZADA
Middle Name:K
Last Name:WOOTEN
Suffix:
Gender:
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HUXLEY CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 E MAIN ST STE C4
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3729
Practice Address - Country:US
Practice Address - Phone:803-881-4787
Practice Address - Fax:803-369-8739
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5363225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist