Healthcare Provider Details

I. General information

NPI: 1972777365
Provider Name (Legal Business Name): ALMA S. MIZE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 LAUREL DR SW
AIKEN SC
29801-3360
US

IV. Provider business mailing address

812 LAUREL DR SW
AIKEN SC
29801-3360
US

V. Phone/Fax

Practice location:
  • Phone: 803-644-1164
  • Fax:
Mailing address:
  • Phone: 803-644-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number517
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: