MEDICARE: MRS. JULIA B HETHERINGTON MHS OTR CHT

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	1092	SC

General Provider Information

NPI Number	:	1255315024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA B HETHERINGTON MHS OTR CHT

Provider Business Mailing Address
First Line	:	18 PROFESSIONAL VILLAGE CIRCLE
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907
Country	:	US
Telephone Number	:	843-521-9673
Fax Number	:	843-986-9369

Provider Business Practice Location Address
First Line	:	18 PROFESSIONAL VILLAGE CIRCLE
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907
Country	:	US
Telephone Number	:	843-521-9673
Fax Number	:	843-986-9369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	09/22/2011

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