MEDICARE: EMPOWER PEDIATRIC 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	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1285311647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWER PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	802 E MARTINTOWN RD STE 408
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-5328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 E MARTINTOWN RD STE 408
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-5328
Country	:	US
Telephone Number	:	803-226-7072
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	JAMIE HOLMES
Credential	:	OTD, OTR/L
Telephone Number	:	803-226-7072

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	01/11/2026

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