MEDICARE: ORIGIN PELVIC HEALTH AND OCCUPATIONAL THERAPY LLC

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
1	225X00000X	Occupational Therapist
2	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1104683168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORIGIN PELVIC HEALTH AND OCCUPATIONAL THERAPY LLC

Provider Business Mailing Address
First Line	:	116 GRANGE LN
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907
Country	:	US
Telephone Number	:	843-812-1958
Fax Number	:

Provider Business Practice Location Address
First Line	:	1718 RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1927
Country	:	US
Telephone Number	:	843-812-1958
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EMILY KIMMINS
Credential	:	OTD, OTR/L
Telephone Number	:	843-812-1958

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	05/21/2025

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