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NPI Code Detail

MEDICARE: JORDAN KATIBETH COLLINS OTR/L

MEDICARE: JORDAN KATIBETH COLLINS 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
1225XP0200XPediatric Occupational TherapistOT.5685SC

General Provider Information

NPI Number : 1205477353
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN KATIBETH COLLINS OTR/L
Provider Business Mailing Address
First Line : 2065 BALMORAL DR
Second Line :
City : ROCK HILL
State : SC
Zip : 29732-8841
Country : US
Telephone Number : 803-372-7297
Fax Number :
Provider Business Practice Location Address
First Line : 85C VINCENT DR
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-4030
Country : US
Telephone Number : 843-425-7963
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2019
Last Update Date : 09/30/2019

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