MEDICARE: MS. JANE D VANWYKE

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	620	SC

General Provider Information

NPI Number	:	1952473670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE D VANWYKE

Provider Business Mailing Address
First Line	:	31 BEE RIDGE CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6702
Country	:	US
Telephone Number	:	803-788-6195
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD
Second Line	:	SUITE 24
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4304
Country	:	US
Telephone Number	:	803-736-5540
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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