Healthcare Provider Details

I. General information

NPI: 1750573457
Provider Name (Legal Business Name): LINDSAY M. BUSHA O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N FANT ST
ANDERSON SC
29621-5708
US

IV. Provider business mailing address

800 N FANT ST
ANDERSON SC
29621-5708
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-1198
  • Fax: 864-512-3608
Mailing address:
  • Phone: 864-512-1417
  • Fax: 864-512-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3304
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3304
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerLICENSE #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: