MEDICARE: MRS. MICHELLE A HENRY OT

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	225XH1200X	Hand Occupational Therapist	2792	SC

General Provider Information

NPI Number	:	1841362878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE A HENRY OT

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-527-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 CROW LN STE 201
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-1663
Country	:	US
Telephone Number	:	843-848-5001
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	12/12/2025

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