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NPI Code Detail

MEDICARE: MIRA KRAFT OTR/L

MEDICARE: MIRA KRAFT OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist4001SC

General Provider Information

NPI Number : 1003213323
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRA KRAFT OTR/L
Provider Business Mailing Address
First Line : 852 CENTERWOOD DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29412-3513
Country : US
Telephone Number : 267-322-9229
Fax Number :
Provider Business Practice Location Address
First Line : 2230 ASHLEY CROSSING DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5700
Country : US
Telephone Number : 843-766-5228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2014
Last Update Date : 12/02/2014

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Directions to “ MIRA KRAFT OTR/L” Practice Location

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