Healthcare Provider Details

I. General information

NPI: 1124947742
Provider Name (Legal Business Name): HANNAH FEDOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 RED CEDAR ST STE 9
BLUFFTON SC
29910-8967
US

IV. Provider business mailing address

254 RED CEDAR ST STE 9
BLUFFTON SC
29910-8967
US

V. Phone/Fax

Practice location:
  • Phone: 843-970-2899
  • Fax: 843-815-6998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5796
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: